“Even Dead Bodies Must Work”

Summary

If you say
you’re sick, the warden just kicks you and says, “Even dead bodies
must work.”

—Musa, Muduuma
Prison, November 12, 2010

The prisoners at Muinaina Farm Prison have been forgotten by
the Ugandan criminal justice system. Almost two thirds of the inmates on this
rural hilltop have never been convicted of a crime. Some have not set foot in a
courtroom in five years. Prisoners plead guilty just to know their date of
release. Yet the backlog in the courts allows the prison authorities to profit
from these forgotten prisoners because every day the prisoners at Muinaina go
to work, farming the lands of the Uganda Prisons Service (UPS), producing the
maize meal that feeds inmates at other prisons. Or they dig on the
wardens’ personal farms, growing produce that the wardens sell for
personal profit. Or they work for private farmers in the area, who pay the
prison authorities. On the farms, they are brutally beaten for lagging behind.

They sleep on a cement floor, crowded together in hot cells.
There is hardly any medical care available: HIV-positive prisoners are sent to
work and are only sometimes excused when they are too weak to keep up; then
they may be transferred to Kampala for treatment. Some prisoners cough,
violently, night after night, their lungs possibly full of drug-resistant
tuberculosis (TB), which is being spread to those around them. “Help us,
we’ll die,” pleaded 10 of the prisoners in a note transmitted to
Human Rights Watch.

In Uganda, prison conditions at a few, larger, regional
prisons have improved in recent years because of the enactment of the new
Prisons Act in 2006, partnerships with a few international donors on health,
and the work of the Uganda Prisons Service. At these prisons, prisoners can
usually access HIV testing and treatment and general healthcare. Overcrowding
is less severe and clean water is usually available. But at many of the others,
including Muinaina, the conditions and treatment rise to the level of cruel,
inhuman or degrading treatment, and even torture.

Between November 2010 and March 2011, Human Rights Watch
interviewed 164 prisoners and 30 prison officers at 16 prisons across Uganda, as part of a series of reports on health in prisons in
Africa. Human Rights Watch found that poor conditions, forced and
corrupt labor practices, routine violence at the hands of prison wardens,
infectious disease, and inadequate medical care threaten the lives and health
of the 50,000 inmates who pass through Uganda’s 223 prisons each year.

The conditions at some Ugandan prisons are improving
but—particularly in rural, former locally administered prisons—are still
far below international standards. Overcrowding is endemic, with prisons
nationwide at 224 percent of capacity. Of the 16 prisons visited by Human
Rights Watch, all but one was significantly over its official capacity, in one
case rising to a staggering 3,200 percent of capacity. Prisoners often sleep on
one shoulder, packed together so that they can only shift if an entire row
agrees to roll at once.

Prison food is nutritionally deficient, leaving inmates
vulnerable to infections and in some cases blind; sex is sometimes traded by
the most vulnerable for additional food. Water is often unclean or unavailable.
At some prisons, boiled water has become a commodity sold by inmates with
kitchen privileges. Proper hygiene is difficult with limited
government-provided soap, and lice and scabies are rampant. Mosquitoes and
malaria are a constant threat, but the prison administration has only sprayed
with insecticide at three prisons, and bed nets are forbidden for male inmates
because of security fears.

A brutal compulsory labor system operates in rural prisons
countrywide. Thousands of prisoners, convicts and remands, are forced to engage
in hard labor—cultivating crops, clearing fields—day after day.
Compulsory labor is often combined with extreme forms of punishment, such as
beatings to punish slowness, and handcuffing, stoning, or burning prisoners who
refuse to work. Few prisoners receive proper medical care for their injuries,
and prisoners are regularly refused access to medical care because officers
will not allow them to miss work. Prisoner productivity translates directly
into profit for prison authorities, but prison authorities often do not account
for the funds raised through prison labor.

In addition to abuses in the fields, prisoners are beaten
and abused within the prison, allegedly as punishment. Inmates are also
sometimes confined in isolation cells, often naked, handcuffed, and sometimes
denied food; the cells are sometimes flooded with water up to ankle height. Some
have had their hands or legs broken, or have become temporarily paralyzed as a
result of beatings, and seldom receive medical care. Prisoners with mental
disabilities are in some cases targeted for beatings, and even pregnant women
are not spared.

The prevention and treatment of disease pose major problems
in Uganda’s prisons. TB spreads quickly in the prisons’ dank,
overcrowded, and poorly ventilated wards. TB prevalence in the prisons is
believed to be at least twice that in the general population, which already is
one of the world’s highest. While the prisons service has recently rolled
out TB entry screening at 21 prisons, more than 200 still offer none. Prisoners
routinely reported having coughed for long periods without having been tested
for TB. TB treatment is only available in the prison medical system at
Murchison Bay Hospital in Kampala, but even those inmates transferred for
treatment may not stay long enough to be cured. TB patients are sometimes sent
back to prisons where continued treatment is not possible in order to perform
hard labor or ease prison congestion. The result may be drug resistance or
death.

HIV prevalence in Ugandan prisons is estimated to be
approximately 11 percent, almost twice national estimates. And although sexual
activity among male inmates is acknowledged by prison authorities, condoms are
universally prohibited because consensual sexual conduct between people of the
same sex is a criminal offence. While just over half (55 percent) of the
prisoners Human Rights Watch interviewed had been tested for HIV while in
prison, rates were much lower at smaller, rural prisons. However, for those who
are positive, treatment may be unavailable. Of Uganda’s 223 prisons,
prison-based antiretroviral therapy (ART) is only available at Murchison Bay,
and even there, ART is sometimes unavailable to those in need of it according
to national protocols.

Under Ugandan law, people with mental disabilities should
not be detained in prison. But a backlog of prisoners awaiting mental
competency determinations, and still more who develop mental health problems
once incarcerated, create a significant need for mental health services within
the prison system. At upcountry facilities, mental healthcare is nonexistent;
even at Murchison Bay, treatment consists only of medication prescribed by a
visiting psychiatrist and dispensed by other inmates, with no attempt at
psychotherapy or other forms of alternative mental healthcare. Inmates with
mental disabilities at some prisons are simply isolated in punishment cells
with no treatment.

The health needs of pregnant women are also largely unmet. Pregnant
inmates receive little or no prenatal care. Pregnant and nursing women usually
receive the same nutritionally deficient food as all other prisoners. And
pregnant women are forced to perform hard labor and beaten just like other
prisoners, leading to reported miscarriage or injury. Protections for women
detainees under regional human rights standards are simply ignored.

The dangerously unhealthy conditions in many of
Uganda’s prisons are in part a result of failures of the criminal justice
system; prison officers’ inappropriate denials or delays in permitting
access to medical treatment; and an under-resourced and inadequate healthcare
system that has received limited support from the government and international
donors.

Prison overcrowding is a direct result of extended pretrial
detention and underuse of the non-custodial alternatives that are available,
such as bail and community service. Fifty-six percent of the Ugandan prison
population has never been convicted of any crime and is by law presumed
innocent. However, remand prisoners often wait for years for their cases to be
resolved and are forced into harsh labor conditions alongside convicts. While
efforts have been made in recent years to address the case backlog, an insufficient
number of judges, judges’ failure to grant bail in accordance with
Ugandan law, and inadequate legal representation still conspire to create
significant remand times, particularly for prisoners awaiting trial before the
High Court. Corruption is reportedly rampant in the criminal justice system,
from arrest through trial, so in some cases those remaining in prison are simply
those unable to pay the necessary bribe. Children are also sometimes held in
adult prisons instead of in juvenile detention facilities, contrary to Ugandan
and international law.

Uganda has repeatedly committed itself to upholding the
human rights of prisoners through its assumption of international and regional
obligations. Under international human rights law, prisoners retain their human
rights and fundamental freedoms, except for restrictions on rights necessitated
by the fact of incarceration itself. Uganda has an obligation to ensure that
its criminal justice and penitentiary standards comply with international and
regional human rights standards, to ensure that detainees are treated with
appropriate dignity and full respect of their human rights, and to prevent all
forms of cruel, inhuman and degrading treatment. Uganda is also required to
ensure adequate healthcare for prisoners, at a standard at least equivalent to
that available to the general population, a commitment acknowledged by the
Uganda Prisons Service. Yet medically unqualified prison officers routinely
assess the health needs of prisoners and then deny their right to access care.

In Uganda, ill-health, hunger, and poor access to healthcare
are not unique to prisoners. However, Uganda has an obligation to ensure basic
minimum conditions and healthcare for detainees, to protect prisoners’
rights and public health. The Ugandan government has a binding and
non-negotiable obligation not to expose people to torture and cruel, inhuman or
degrading treatment, which it currently violates when sending them to prison.

Reform is critical: of prison oversight and management and
of laws and practices that lead to extended pretrial detention. The Ugandan
government and international donors need to prioritize prison funding, while
ensuring that corrupt labor practices end. By building on the advice of its own
medical staff and that of outside human rights monitors, the Uganda Prisons
Service has the opportunity to continue to improve its protection of the rights
and health of prisoners, by eliminating the abusive practices that lead to poor
health.

Key Recommendations

For Immediate Implementation

The Uganda Prisons Service
and Ministry of Internal Affairs should:

Issue
direct orders to stop the use of forced prison labor for private landowners or
prison staff;

Declare a
zero tolerance policy for the beating of
prisoners and warn that staff and inmates will be disciplined and punished for
abuses;

Carry out
regular monitoring visits led by headquarters and medical staff to ensure the
health and well-being of prisoners throughout the country and a halt to corrupt
labor practices;

Provide
condoms to all prisoners and prison staff, in conjunction with HIV/AIDS education
on harm reduction;

Provide
TB screening and offer HIV voluntary counseling and testing to all inmates, and
ensure prompt initiation and continuation of treatment for those with confirmed
disease;

Establish
guidelines for immediate referral of all prisoners with confirmed TB or HIV to
facilities where they will receive treatment, and halt the practice of
transferring inmates on treatment away from prisons with treatment capacity;

Issue
direct orders to all officers in charge to allow inmates reporting illness or
disability to seek healthcare, and to take responsibility for inmate health.

The judiciary should conduct
all bail hearings in open court and the Rules Committee should issue a Practice
Direction setting conditions for bail and guidelines on appropriate amounts in
line with income levels in Uganda.

For Longer-Term Implementation

The Ugandan Parliament and
Ministry of Finance should secure, and international donors should assist with
securing, enough funding for the prison budget to ensure conditions consistent
with international standards, without reliance on income from forced inmate
labor for private landowners.

The Uganda Prisons Service
and Ministry of Internal Affairs should establish guidelines on prison-based
health services and scale up those services to:

Establish
at each prison nationwide at minimum one trained health worker, with a supply
of essential medications;

Conduct
health screenings of all prisoners on entry and at regular intervals;

Ensure
access to prenatal, postnatal, and prevention of mother-to-child transmission
of HIV (PMTCT) services and address the nutritional needs of pregnant women and
breastfeeding mothers;

Ensure
access to mental health services;

Provide
prompt referrals and transfer to higher level facilities in the community or
prison system for appropriate treatment.

The Ministry of Justice
should devise a functional legal aid system to ensure that defendants have
access to a lawyer from the time of arrest.

Methodology

This report is based on 231
interviews, including interviews conducted with 164 prisoners (114 men, 44
women, and 6 children) and 30 prison officers at 16 prisons between November
2010 and March 2011. Prisons were selected to represent a diverse range of
facilities based on type, status (formerly locally or centrally administered),
size, and level of congestion. Access was granted by the commissioner general
of prisons as a part of Human Rights Watch’s routine human rights monitoring
in prisons, regularly carried out in Uganda for several years.

In prisons visited, researchers
identified prisoners to approach for interviews in two ways: 1) according to a
randomized method involving choosing prisoners from the available prisoner
registers, and 2) targeted selection of prisoners to ensure representation of
certain categories, including those who had been transferred from one prison to
another to receive medical care, individuals identified to Human Rights Watch
as having undergone specific types of punishment, and women (particularly women
who had been pregnant or who had cared for a small child while in prison).

Interviews were conducted in
English or in Lubwisi, Luganda, Lukonzo, Luo, Lusoga, Lwamba, Runyoro-Rutoro,
Runyankole-Rukiga, Samia, or Swahili, with translation into English. One
interview was conducted in French. The purpose of the research was explained to
each prisoner, who was asked whether he or she was willing to participate, and
offered anonymity. Prisoners were told that they could end the interview at any
time or decline to answer any questions without negative consequence. All
interviews were conducted privately, with one prisoner at a time. Each prisoner
interviewed and quoted in this report has been given a pseudonym to protect the
prisoner’s identity and for the prisoner’s security; surnames have
been omitted to conceal prisoners’ ethnicities.

Prisoners who were interviewed
averaged an age of 31 years. Overall, the most common charges of the prisoners
interviewed were theft, murder, and defilement. The time the prisoners
interviewed had spent detained ranged considerably between the different types
of prisons visited, averaging 22 months, but highest among prisoners at farm
prisons (on average 48 months). Prisoners often reported having been moved
between prisons, and the time prisoners had spent in the facility in which they
were interviewed also varied considerably, but averaged nine months.

Human Rights Watch researchers
also conducted facility tours and interviewed 30 prison staff members at the 16
prisons visited, in addition to the Uganda Prisons Service medical authority. In
some cases, official titles of individuals are not given for security reasons
or at the request of the individual. At the conclusion of field research, Human
Rights Watch sent a letter to the Uganda Prisons Service commissioner general
of prisons on April 8, 2011, (see Appendix) requesting a response by April 29,
2011 to numerous issues raised in the report; Human Rights Watch did not
receive an official response to this letter within the timeframe. Human Rights
Watch again requested a response on May 13, 2011, and provided an additional summary
of the issues presented in the report on May 16, 2011, at the request of prison
authorities. An email response from prison authorities to some of the questions
Human Rights Watch had posed was received by email on May 19, 2011, and by
letter on June 29, 2011, as this report went to press. That information is
reflected throughout the report.

Researchers also interviewed 15
members of the communities surrounding Sentema, Kasangati, and Ntenjeru Prisons
(all Central Region), and three prison officers at those prisons, specifically about
the practice of hiring out prisoner labor to private landowners.

Finally, researchers interviewed
18 representatives from local and international organizations working on prison,
HIV/AIDS, and health issues; health workers within the Ugandan government; and
donor governments and agencies.

Caution should be taken in
generalizing the results of this research to all prisoners in Uganda. Because
Human Rights Watch oversampled prisoners in Kampala-area prisons, which have
greater resources than rural prisons, the percentage of prisoners receiving
medical testing and care in this report may be greater than the national
average. Also, the selection of prisoners within each prison was not perfectly
representative. Researchers tried to systematically and randomly select
prisoners; however, this was not always possible. Because of the diverse
conditions among prisons and because specific groups of prisoners (noted above)
were intentionally oversampled, Human Rights Watch has, to the greatest extent
feasible, presented disaggregated data according to prison and prisoner type.

This report is part of a series of reports on health in
prisons in Africa by Human Rights Watch. The objective of the series of reports
is to examine health and human rights issues in prisons in Africa in the
context of diverse health and justice policy, reform efforts, and resource
availability.

I. Background

The Ugandan Prison System

Uganda
has 223 prisons countrywide. Designed to house 13,670, in March 2010 Ugandan
prisons were at 224 percent of capacity, with 29,136 male and 1,278 female
prisoners in custody.[2] The Uganda Prisons Service
employs 6,700 staff, including 6 physicians.[3]

In
addition to prisons run by the central government, prior to 2006, local
governments administered independent prisons, at which conditions were
reportedly grossly inadequate.[4] The Prisons Act of 2006
transferred the functions and administration of these locally administered
prisons to UPS,[5] to create
one nationwide system. Significant problems remain at the over 170[6] former Local
Administration Prisons (LAPs).[7] Although approximately one
third of Uganda’s prisoners were housed in former LAPs in March 2010,[8] prisoners in former LAPs
constitute the majority of those not served by prison-based health facilities.[9]

Currently,
UPS operates two official categories of prisons: reception centers and farm
prisons. Although practice varies, in general, remandees and prisoners
convicted of petty offences (with sentences less than one year) are kept at
reception centers; male prisoners convicted to serve sentences over a few
months but less than 10 years, or those with a short period of time remaining
on their sentences, are sent to farm prisons. Remand or convicted prisoners
facing or serving sentences over 10 years are sent to maximum security
reception center prisons.Individual officers in charge (OCs) of
prisons are empowered to decide which prisoners, including
those undergoing medical treatment, to move to farm prisons; they do so without
consultation with medical officials and their decisions are not subject to
review.[10]

There is a separate juvenile justice system, with five
facilities for children accused or convicted of criminal offences nationwide.[11]
Though official statistics indicated no children held in prisons during
2009-2010,[12]
in practice children are detained with adults in some.[13]

By law, UPS “shall be provided with adequate resources
and facilities.”[14]
UPS funding derives from the government of Uganda, donor funding, and
“internally generated” revenue.[15]
OCs set their budget priorities, which are reviewed and decided upon by prison
headquarters in Kampala, with supplies coming almost exclusively in the form of
the items requested. The receipt of these items is erratic and undersupply a
general problem.[16]

Management
of health in prisons is overseen by the Ministry of Internal Affairs, the line
ministry for the UPS.
UPS has
calculated that it spends 17,073 Uganda shillings (US$6.96) per prisoner
annually on health when dividing its health budget by the prisoners, staff, and
staff dependents who use its services; that figure drops to 4,830 Uganda
shillings ($1.98) annually per prisoner when factoring into the calculation the
members of the neighboring communities who access prison-supplied health
services.[17]

Officially,
the total UPS health budget was increased by 55 percent between fiscal year
(FY) 2009/10 and FY 2010/11.[18] Yet the overall proportion of
the prison budget allocated for health services remained a flat two percent.[19] By comparison, the
government provides roughly 9 to 10 percent of its national budget to healthcare.[20] In 2009, the commissioner
general of prisons admitted to the media that lack of funding had led to
deteriorating infrastructure and health in Ugandan prisons.[21]

Health
services for the prisons are headed by a national directorate in Kampala. As of March
2011, 63 of Uganda’s 223 prison units had some level of healthcare
worker. At the rest, prisoners were expected to rely on the health facilities
in the neighboring communities.[22]

The
national referral hospital for prisoners is at Murchison Bay Prison in Kampala. Murchison Bay Hospital
treats prisoners temporarily referred from other prisons to receive inpatient or
outpatient medical treatment,[23] and is the only medical
facility in the prison system accredited to provide TB treatment and antiretroviral
therapy for HIV treatment.[24] The UPS has established 10
regional health units intended to oversee delivery of healthcare services.[25] Forty-nine additional health
“units” across the UPS have healthcare workers. But, in practice,
the capacity of many of the facilities is limited: according to the prison
medical authority, “we have no doctors at all in the upcountry units, we
have zero.”[26]

The Ugandan Healthcare System

While the UPS often relies on community-based health
services for prisoner care, healthcare for Uganda’s general population
suffers from numerous problems. Uganda’s healthcare system ranks 186th
out of 191 countries according to the World Health Organization (WHO).[27]
Life expectancy is among the lowest in the world at 52 years; 1 in every 35
women dies as a result of giving birth.[28]

In national healthcare facilities, only half of all posts
are filled.[29]
Access to healthcare in poor rural areas is especially difficult. Around half
of the population does not have any contact with modern healthcare facilities.[30]
Some 70 percent of Ugandan doctors and 40 percent of nurses and midwives are
based in urban areas, serving only 12 percent of the population.[31]

Healthcare centers,[32]
often in dilapidated condition, frequently house patients together in wards, with
no privacy regardless of gender or condition.[33]
Medical equipment is lacking and where available, often there is no staff,
electricity, or water.[34]
The government does not supply sufficient drugs and equipment countrywide,
leading to frequent drug stock outs and lack of basic supplies such as gloves
or disinfectant.[35]

II. Findings

The engagement of a prisoner in doing
work as a principle would be ok, but it has to be closely supervised so that it
is not abused.... There seems to be an insensitivity when it comes to the
mobilization of labor. If a prisoner is on TB treatment, ARVs—you send
him to where there are no services? … If they are on TB treatment, and
you take them to a farm, you create drug resistance.

—Prison medical authority, Uganda
Prisons Service, November 18, 2010

Prison
Conditions

Overcrowding

Overcrowding in Ugandan prisons is endemic and by 2019, the UPS
projects the prison population will more than double.[36]
Contrary to international and Ugandan law requirements that accused people and
convicted prisoners be held separately,[37]
at every prison visited, all categories of prisoners (convict, remand, and
debtor[38])
were mixed.[39]

Although international
standards establish basic requirements with respect to prisoners’
accommodations, including with regard to ventilation, floor space, bedding, and
room temperature,[40]
15 of the 16 prisons visited by Human Rights Watch were significantly over
their official capacity. Fort Portal Women’s Prison was slightly
undercapacity; Muduuma Prison, by contrast, was filled to a staggering 3,200
percent of capacity.[41]
Prisoners reported wards routinely sleeping twice or three times their design
capacity, and prison officers confirmed that congestion is a major problem.[42]
At Luzira Upper, in one ward 124 prisoners packed into a space eight meters
square.[43]

Prisoners complained about suffering each night in this
limited sleeping space and described being “squeezed like iron
sheets,”[44]
“like chickens,”[45]
or arranged nightly by a designated inmate “like logs,”
“firewood,”[46]
or “sacks of beans.”[47]
Most often, prisoners told Human Rights Watch they were forced to sleep in
lines, on one side, so packed together that if one turned to his other side,
his entire row was forced to do so.[48]
Occasionally, also, prisoners reported being forced to sleep in turns,[49]
or seated or standing.[50]

Many prisoners said that they slept without any mattress;
prisoners frequently reported being given one blanket to lie on and cover
themselves. Sometimes two inmates shared a single blanket or mat. Occasionally, prisoners said they were not allowed to have
a mattress, lest the ward become so crowded that its inhabitants would not fit
in the room.[51]

Such tightly packed wards allow for little ventilation in
contravention of international standards.[52]
Inmates repeatedly complained of the heat in the congested cells: “We
sweat from the bones.”[53]
William said, “When your neighbor sweats, all the sweat will be on you.”[54]

At a few prisons, prisoners are forced to stay in their
crowded cells day and night. Ugandan law provides that each prisoner have at
least one hour of exercise in the open daily.[55]
But at Masaka Ssaza and Butuntumura Prisons, the majority of prisoners spent
all day and night locked in the overpacked cells because of security concerns
about the prison’s perimeter[56]
and were permitted outside for only 20 minutes a day.[57]

Food and Nutrition

Deprivation of food in prison constitutes an inhuman
condition of detention in violation of the International Covenant on Civil and
Political Rights.[58]
International standards require that prisoners be supplied with “food of
nutritional value adequate for health and strength, of wholesome quality and
well prepared and served.”[59]
Under Ugandan law, prisoners are entitled to nutritious food “adequate
for health and strength.”[60]

At every prison visited, prisoners reported being given posho
(maize meal) and beans once or twice daily, sometimes accompanied by a small
portion of porridge for breakfast. Despite a
recommended dietary scale including nuts, meat, vegetables, and sugar,[61]
prisoners receive only maize meal, beans, and salt.[62]
Greens grown by prisoners supplement the rations seasonally at some prisons.
However, at others, prisoners reported that the officers confiscated all or a
portion of the vegetables grown by prisoners.[63]
Mark, at Muinaina Farm Prison, concluded: “We eat greens, but like a goat
tied on a rope, the eating is controlled.”[64]

Most prisoners said that the government-provided food was
not enough. Prisoners doing hard labor in particular considered food portions
insufficient.[65]
Julius, at Kitalya Farm Prison, said, “We are eating crumbs. However much
energy we use, it is not enough.”[66]
Medical personnel and a nutritional assessment conducted by the UPS agreed:
“it is not enough for doing hard work.”[67]

Indeed, death records provided by UPS prison authorities to
Human Rights Watch indicated that at least one prisoner died in 2010 from
malnutrition.[68]
The adequacy of the diet in terms of micro-nutrients was also a concern. The prison
medical authority noted that:

There is a deficiency in terms of
micronutrients, including A and C. Vitamin A is important in the immune system
and eyes; vitamin C is important in cellular regeneration when recovering from
diseases. These are important because we’re having a population of
prisoners vulnerable to infections, and their capacity to recover from and
fight off infections is grossly compromised. We see the cases of malnutrition….Especially
the long-termers—they develop blindness, and infections like TB.[69]

The lack of adequate
nutrition is particularly problematic for pregnant women prisoners and women
with small children in prison. Under Ugandan law, “[a] female prisoner,
pregnant prisoner or nursing mother may be provided special facilities needed
for their conditions.”[70] Some women occasionally reported receiving
supplemental milk or eggs during their pregnancy.
[71] However, pregnant women typically do not receive
extra food rations; they eat exactly the same diet as other prisoners.[72] At Jinja Women’s Prison, those pregnant women
who had been exempted from hard labor ate an even less nutritious diet than
their non-pregnant colleagues because they did not grow greens which they could
eat.[73] Harriet, a new mother at Masaka Main, concluded:
“The food we eat doesn’t generate breast milk.... I’m
breastfeeding but it’s not enough.”[74] If prisoners choose not to breastfeed, or are unable
to breastfeed, they do not consistently have access to formula or safe water
with which to prepare it.[75] Despite international standards calling for special
provisions for children incarcerated with their parents,[76] and Ugandan law requiring children imprisoned with
their mothers to be supplied with “necessities of life,”[77] food is not generally provided for these young
children.

Uganda’s own auditor general
concluded that the UPS, given its budget and the food grown on farm prisons,
would have the capacity to feed prisoners a sufficient diet, but that due to under-declaration
and lax oversight of farm production by prison OCs, prisoners’ diets
remain inadequate.[78]
“[D]ishonest business practices like delivering less quantities of food
items,” lack of prioritization (and reallocation of budgeted resources)
for food, and the practice of taking prisoners to work on private instead of
prison farms led to inadequate food for prisoners.[79]

Water,
Sanitation, and Hygiene

There is no permanent water here. The
kind of water we use is from the ponds we dig.… When you’re in the
gardens, some people who are thirsty, if they come across stagnant water, kneel
down and drink it. They drink it without the permission of the warden. But if
you’re found drinking like a cow, they beat you.

—Martin, Bubukwanga Prison,
November 16, 2010

Prisoners frequently told Human Rights Watch that water was
insufficient in quantity and that they were constantly thirsty: “Sometimes
we get water, sometimes we don’t. There are times we spend a day without
drinking.”[80]
At Kitalya Farm Prison, prisoners reported that each received approximately one
liter of drinking water a day,[81]
but it was not enough after a day of hard labor in the sun.[82]
Officers in charge confirmed difficulties in supplying their prisons with
sufficient quantity of water.[83]

At Bubukwanga Prison, inmates told Human Rights Watch that
water did not consistently run from the tap, and they were forced to drink
“stagnant water in the roads,”[84]
full of small insects,[85]
and green or brown in color.[86]
At Muinaina, researchers observed the drinking water to be a cloudy olive green
color. The OC at Muinaina described the water as “dirty white” and
admitted, “It’s not clean.”[87]
Indeed, at some prisons, boiled water has become a commodity sold in the cells
by inmates with kitchen privileges, in exchange for soap, sugar, or money to
those who can afford it.[88]

Under international standards, prisoners must be provided
with adequate bathing installations for general hygiene,[89]
yet bathing facilities at many Ugandan prisons fall far short of this standard.
At Masafu, five prisoners share one basin of water to bathe each day.[90]
At Muduuma, prisoners reported that no bathing water at all was provided.[91]

International standards specify that sanitary facilities
shall “enable every prisoner to comply with the needs of nature when
necessary and in a clean and decent manner.”[92]
Despite efforts to overhaul sewage systems at a few prisons in recent years,
prisoners at some prisons reported inadequate toilet facilities including the
use of buckets.[93]
“The most inhuman thing here is the bucket system” that inmates use
at night, the OC at Masafu said.[94]
At Muduuma, prisoners complained that they were sometimes refused permission to
use the existing toilet facilities because they were located outside of the
prison’s perimeter, and received beatings for making the request.[95]

International standards also require that prisoners shall be
provided with toilet articles necessary for health and cleanliness[96]
and separate and sufficient bedding that is “clean when issued, kept in
good order and changed often enough to ensure its cleanliness.”[97]
Ugandan law makes provision for prisoners to receive toiletries.[98]
Yet, across prisons visited, prisoners and prison officers frequently reported
an inadequate supply of such basic necessities. Prison officers admitted that,
to give prisoners soap on a regular basis, part of the funding had to come from
the proceeds of prisoner labor on private farms.[99]

Physical Abuse

Hard Labor

Thousands of prisoners are forced to engage in hard labor.
They cultivate crops, clear fields, or fetch firewood and water. Prisoners,
convicted or on remand, work often in oppressive conditions, in heat or rain,
sometimes intentionally denied food, water, or bathroom breaks.[100]
They are beaten as punishment for being slow or to instill fear upon arrival at
prison, handcuffed, stoned, or burned if they refuse to work. Vulnerable
prisoners, including children, the sick, elderly, and pregnant women are also
beaten and forced to work.[101]

International legal standards place important constraints on
how prison labor may be used. Under the United Nations (UN) Standard Minimum
Rules for the Treatment of Prisoners, adopted by the United Nations as
guidance, prison labor must not be of an afflictive but rather of a vocational
nature, and prisoners should be allowed to choose the type of work they wish to
perform.[102]
The work must not be driven by financial profit motives.[103]
No prisoner, whether remand or convict, should be forced to work for private
entities, such as private landowners.[104]
When working for the government, only convicts and not remands may work, and
they must be medically assessed to see if they are fit and healthy for work,[105]
they must be treated and remunerated fairly on terms close to what free workers
receive, they should be male and between the ages of 18 and 45, and may not
work more than 60 days a year.[106]
Currently, Ugandan prisons do not comply with any of these international
standards.

The practice of compulsory labor is longstanding in Ugandan
prisons. In 2003 the government of Uganda wrote in its report to the UN Human
Rights Committee that the “illegal and exploitative” practice of
hiring prisoner labor to private individuals is a “common feature.”
Enforced hard labor of non-convicts was at the time “rampant and
therefore tantamount to painful punishment without conviction.”[107]
In April 2011 according to the government-owned New Vision newspaper,
the Uganda Prisons Service announced a new policy to the parliamentary public
accounts committee that all prisoners would be paid 100 to 500 Uganda shillings
($0.04 to $0.21) per day for labor.[108]
At time of writing, it was unclear to what extent this new policy had been put
into practice.

While according to international standards, the safety and
health protections in place for non-prison labor are supposed to be in place
for prisoners,[109]
prisoners in Uganda face greater risk of injury compared to free laborers
because of abusive practices, including being made to work closely together or
being beaten so that they will walk quickly through rough terrain without
shoes, “like a herd of cattle.”[110]
Prisoners spend long hours each day doing forced labor,[111]
resulting for many in chest pain, ulcers, and fatigue.[112]

Many prisoners said they had to work while actively ill or
injured, particularly if they suffered from illnesses that were not immediately
visible. Prisoners often said that “there was no time to go to the
hospital” because they were forced to work in the fields and were denied
permission to miss work in order to receive care.[113]
One prisoner, echoing an expression heard many times by researchers, said that
prison authorities “were telling us we didn’t come to a hospital,
we came to a prison and should work.”[114]The health consequences of prisoners’ hard labor may be severe: One
prisoner died in Mubuku Prison while working in the field in November 2010. The
exact cause of his death is unclear, but witnesses who saw the incident
recounted that he was beaten and his numerous expressions of thirst and
requests for water went ignored by prison authorities.[115]

Abuse in
the Fields by Wardens and Other Inmates

They [the wardens] took the sick to
work. They would take me to dig. They used to start the digging at 6am, and dig
at high speed—but when the sun would rise up and the heat raise, I
started feeling dizzy and in most cases I would fall down. I was beaten by the katikkiros
[prisoners with disciplinary authority], claiming I was faking illness, until
one time when this happened to me, the katikkiros beat me, but the
wardens stopped them because I couldn’t move, and they ordered I should
be taken back to the prison. I lost consciousness, only to wake up to see I was
in the ward.

At the 11 prisons visited by Human Rights Watch where
prisoners were engaged in compulsory labor, prisoners reported routine, brutal
beatings in the fields.

Prisoners said they were beaten by both prison officials and
other prisoners with disciplinary authority, most commonly with sticks or
canes. Beatings occurred for a range of reasons: if prisoners lagged behind
others in their work, if they said they were sick, if they made errors in their
work, if they straightened up to stretch their backs.[116]
At Kitalya Farm Prison, Human Rights Watch researchers observed a prisoner with
disciplinary authority hitting prisoners with a stick as they unloaded maize
from a truck.[117]

Prisoners at Muduuma and Kitalya Prisons said new arrivals
were beaten in order to preemptively instill fear, as work in open fields
heightened the opportunity to escape.[118]
Some were beaten together in groups as large as 25, each with legs and hands
tied behind his back with rope.[119]
Wardens and other prisoners then beat them with sticks, batons, or slashers, metal
rods with a blade used typically for cutting grass.[120]

At some prisons, prisoners reported unique and especially
brutal punishments. Four prisoners from Muinaina Farm Prison independently
confirmed that prisoners who worked slowly had dried grass or banana leaves
placed on top of them and set afire.[121]
One was himself a victim while the remaining three said they observed this
practice in at least two incidents in 2009. One from Muinaina Prison said he
was forced to sit on an anthill to suffer ant bites.[122]
Remand prisoners at Muinaina once refused to go to work in the fields after a
new OC initiated a policy of making all prisoners, whether remand or convict,
work. They were handcuffed to a tree all day, every day, until they succumbed.[123]
Female prisoners from Jinja Women’s Prison recounted working in
waist-deep water to cultivate rice for the wardens, as leeches attached to
them.[124]
The wardens, themselves unwilling to get wet, threw stones at prisoners to
punish them.[125]

Despite the prohibition in Ugandan law that “[a]
prison officer shall not employ a prisoner in the punishment of a fellow
prisoner,”[126]
and prohibitions in international standards on prisoners being employed in any
disciplinary capacity,[127]
some prisoners are given authority to punish other prisoners. One prisoner who
was promoted through the ranks said that the prison authorities told him,
“Don’t go back to the hoe. Now you have a stick.” He
described an intricate hierarchical system in which he oversaw other prisoners,
who themselves oversaw squads of 20 prisoners, called a “bicycle.” He
said, “I can even beat commanders and say, ‘Your bicycle is not
moving.’” If he beat a commander, the commander was then required
to beat all 20 prisoners in his bicycle.[128]

The Economic
Incentives behind Prison Labor

The money they are receiving for us,
where do they put it?

—Ali, a former inmate at a farm
prison, interviewed at Murchison Bay Prison, November 20, 2010

Testimony of forced hard labor and abuses was most frequent
at farm prisons, or former LAP prisons in rural agricultural communities.
Prisoners at those prisons said that they were hired out to work on land for
private farmers and on land owned or rented by prison authorities. Because
their productivity translated directly into profit for prison authorities, who
sold the food harvested from their land or were paid per job by private
landowners, they forced prisoners to work for long hours, with little rest,
even despite illness or injury.

Prison OCs told Human Rights Watch that they needed the
income produced by prison labor to meet the operating costs of the prisons.[129]
Four OCs said that they received only 150,000 Uganda shillings (approximately
$63) or less per month in addition to in-kind supplies from the prison
administration in Kampala, leading to a shortfall which they met by contracting
out prison labor.[130]
As one OC said, “From the working arrangement, we use the money [the
prison receives for private work], if it wasn’t there, then we
wouldn’t be surviving, we wouldn’t be running the institution.
Because of that, we buy milk for the kids, we buy fuel and repair the vehicle,
we put a latrine in the female section.”[131]
Another OC explained that, “Labor is not part of their sentence. Labor is
just an activity that we subject them to for us to be able to keep them and
rehabilitate them somehow.”[132]

OCs said that the prison administration knew of and indeed
encouraged the practice of contracting out prison labor, as it was a display of
initiative by OCs to ensure that their prisons were well run. One OC reported:

There is a language of initiative in
the prisons. But they need to define the limits. The regional command had
already told the commissioner, no prison in the region will be using a bucket
toilet. He said to us, we should put water-borne toilets in the ward at your
cost, don’t ask for any money. By December, all prisons in the Eastern
region will be using water-borne toilets. But it is an uphill task….I
talked to an engineer, and that will take 12 million shillings [approximately
US$5,100].[133]

Prison authorities are not required to account fully to the
prison administration in Kampala for the earnings from contracting out prisoner
labor, potentially fueling corruption. One OC said that a senior colleague,
also in the UPS, had told him when he was promoted, “Eat on the job, but
don’t eat the job,” which he took to mean that it would be
acceptable to personally gain from prison labor as long as he ensured that the
prison could operate.[134]
An OC of a farm prison informed Human Rights Watch that he intentionally
underreported the amount of food his prisoners produced.[135]
Uganda’s auditor general has criticized the “laxity in supervision
and accountability for the food grown on the prison farms.”[136]

Generally, three models of prison labor exist. In the first,
prisoners work on official farm prisons, farming government-owned land.[137]
The produce from this activity is intended to go to Kampala for distribution to
prisons nationwide. However, sometimes prison officers keep behind a portion of
it to meet prison operating expenses. One OC said:

We declare estimates to Kampala [UPS
headquarters]. If we expected 100 bags [of produce], we declare 80. You
can’t complain to the boss all the time, or else he will call you a
failure. You have to take your initiative. The resources we get from the
central government are small, minute. Maybe the government should inject in
more funds. The 20 bags sold off don’t make it into the books. The
auditors don’t understand.[138]

Second, prisoners are contracted out to private farms at rates
ranging from 2,500 to 3,500 Uganda shillings (roughly $1.00 to $1.50) per head
per day, significantly lower than what free workers would earn, approximately
7,000 to 10,000 Uganda shillings ($3.00 to $4.25) a day.[139]
Private farmers hire prisoners to work on their own land and pay the prison OC
directly for the labor. Prison staff takes bookings for prison labor by phone
or in person, and payment must be made in advance.[140]
Injuries sustained by prisoners while working on private land are the
responsibility of the prison and not the private farmer.[141]
Private farmers must pay for transportation of the prisoners and may rent
additional equipment such as hoes from the prison. They are responsible for
providing some food for the prisoners and may also pay the accompanying wardens
tips ranging from 5,000 to 15,000 Uganda shillings ($2.00 to $6.25) per day per
warden to ensure that prisoners’ productivity is high.[142]

According to prison authorities, hiring labor out to private
landowners can be done by the OC “for improvement of administration
of his Prison.” It “can only be done as a form of employment in
which the inmates will have to earn a statutory fee.”[143]
Only prisoners who have been convicted of petty offences are permitted to work
on private land.[144]
Currently, Ugandan prisons violate their own policy.[145]

Media reports have speculated that wide-ranging police
sweeps of people in slum areas of Kampala have been driven by the prison
authorities’ desires to have free manpower to contract out to private
landowners.[146]
Prisoners at Muduuma Prison told Human Rights Watch that police engaged in
large-scale street sweeps, accusing them of being “rogue and vagabond,”
a vaguely defined crime akin to loitering, releasing those who could pay and
taking the remainder for hard labor.[147]

In the third model, prisoners cultivate directly for prison
OCs and wardens, who sell the produce at a profit. Officially, prison officers
can have prisoners work on officers’ own “small gardens…usually
once a week on Saturdays.”[148]
One OC stated that he personally earned approximately 1,000,000 Uganda
shillings ($425) per season and estimated his wardens each made 500,000 to
600,000 Uganda shillings ($200 to $250) per season, the equivalent of two to
three months’ wages, by selling the produce that prisoners cultivated on
their land.[149]
Prisoners with prior experience in agricultural trade placed estimates of the
OC’s stock to be several times the amount he reported to Human Rights
Watch.[150]
Inmates at the same prison, where remand times were on average five years,
believed that their prolonged pretrial detention was in part due to the desire
of prison wardens to profit from their labor for a considerable period of time.
Human Rights Watch observed storage at the prison of the OC’s private
maize and rice stock, which he said he planned to sell.[151]
Inmates not only cultivated but also processed the maize from the OC’s
private stock, and some prisoners observed private sellers paying the OC within
prison grounds.[152]
When the prisoners raised the issue of their hard labor with the regional
prisons commander, they received no assurances that any of these practices
would stop.[153]

Wardens and OCs also benefited personally from prisoners in
smaller ways by forcing them to clean their houses or do their laundry,
allegedly stealing church-donated goods or food given as payment for labor, and
in one instance, having them build the OC a new house.[154]

Prison authorities wrote to Human Rights Watch, saying, “Where
prisoners are forced to work without pay, that’s abuse. In my tours,
I am yet to meet this. The Officer in Charge of the Prison must keep an
inventory of these activities that will have to be checked by the Prisons
Inspectorate and the Regional Prisons Commanders.”[155]
However, at Kitalya Farm Prison, where Human Rights Watch had to go to the
fields to retrieve prisoners from their work for interviews, each of the
prisoners interviewed reported that only prisoners with disciplinary authority
are ever paid for their work; all others receive nothing.[156]
Indeed, the vast majority of prisoners Human Rights Watch interviewed who did
hard labor reported being forced to work without pay. At some prisons,
prisoners were paid nominal amounts of money, around 200 to 500 Uganda
shillings per day ($0.09 to $0.21), or received small amounts of food, soap, or
cigarettes as payment, but in most instances, prisoners received nothing.[157]

Punishment

Ugandan law lays out disciplinary procedures for prisons.[158]
And some of the punishments currently inflicted are in line with Ugandan and
international law: Prisoners may lose the possibility of early release,[159]
be given additional cleaning or field work,[160]
or denied visitors.[161]
For serious unlawful offences committed in prison, a prisoner can be criminally
charged, prosecuted, and convicted with an additional sentence.[162]
Yet, at almost every prison Human Rights Watch visited, prisoners
overwhelmingly reported beatings and the use of isolation cells flooded with
water while the prisoner was forced to be naked, beaten, and given limited food
as the primary punishments.[163]

Beatings

They hit me so hard, I was crying
blood.

—Edmund, Muinaina Farm Prison,
March 4, 2011, describing a beating by prison wardens and other inmates

Severe beatings—in the
fields as described above but also in the prisons themselves—conducted as
punishment either by the wardens or by inmates with disciplinary authority,
were reported by prisoners at nearly all prisons visited by Human Rights Watch.
Overall, 41 percent of the prisoners interviewed by Human Rights Watch said
that they had been beaten; 87 percent of prisoners at farm prisons had
experienced a beating.

Corporal punishment is
forbidden in Ugandan prisons[164] and international law forbids cruel, inhuman or
degrading treatment and torture.[165] Prison officers told Human Rights Watch that they
knew corporal punishment was banned and frequently contended that it had been
abolished in practice.[166] Yet prison medical staff acknowledged that they had
observed injuries inflicted by prison wardens: A health worker at Murchison Bay
Hospital reported that most of the injury cases he sees are inflicted either by
police or prison staff,[167] and the prison medical authority admitted that he had
heard of “instances” where “this has cropped up.”[168] Additional human rights monitors have noted the
frequent, continuing, use of beatings, despite its official abolition.[169]

An assistant commissioner of
prisons is charged exclusively “to monitor human rights abuses in
prisons.” According to prison authorities, four OCs have been removed
from their positions due to infractions, and an additional two OCs and two
junior officers are currently facing criminal charges for assault of inmates.[170]

At every prison visited but
one,[171] prisoners reported that caning still takes place; at
most, it is the primary form of punishment. At Bubukwanga Prison, researchers
touring the prison were confronted with a prostrate inmate, writhing on the
floor and moaning in pain. He said: “I’ve been beaten by the OC, he
hit me. He left me very badly off. He said I had stolen, and he beat me with a
big cane. He beat me this morning.”[172] He showed researchers the marks the beating had left
on his body. Other prisoners confirmed that they had seen the OC beat him that
morning, for allegedly stealing some sugar from another inmate.[173]

At some prisons—in
particular Luzira Upper, Fort Portal Men’s, and Muinaina
Farm—prisoners reported marked decrease in frequency and severity of
caning in recent years.However, inmates across facilities still consistently
reported routine beatings by wardens: At one prison, several prisoners
described being held by each arm and leg as they were beaten on the buttocks
and back of the head with a stick.[174] According to one inmate, the OC said, “This is
the stubborn part,” as he beat prisoners’ heads.[175] Prisoners reported receiving beatings of varying
severity, from five strokes to “so many times I could not count.”[176] The instruments include batons, canes, sticks, whips,
electric cable, and wire.

Despite prohibitions in
Ugandan law and international standards on prisoners being employed in any
disciplinary capacity, prisoners with disciplinary authority also mete out
punishments within the prison.[177] At some prisons, prisoners reported having been
beaten by prisoners with disciplinary authority in the wards on the orders of
wardens or as they watched and tacitly approved.[178]

Several prisoners with mental
health problems reported being targeted for beatings by inmates with
disciplinary authority because of their mental disabilities.[179] As Ali, one inmate in the “mental health”
cell at Murchison Bay, observed, “The cleaner [an inmate with
disciplinary authority] will say, ‘Stay in the wards,’ and if you
go out—you are beaten. But these people [with mental disabilities]
don’t see things in the normal sense. They are punishing people for being
mentally sick.”[180]

Table 2: Prisoners Reporting Beatings, Health
Problems as a Result of Beatings, and Medical Care for Their Injuries

The health effects of beatings may be severe. Prisoners
described how beatings in some instances caused loss of consciousness, or
partial loss of hearing,[181]
while others sustained broken legs as a consequence.[182]
One prisoner described how he had been beaten so badly by a warden that he was
unable to walk for a month.[183]
Another prisoner recalled an incident he had witnessed at a farm prison:

They caned him, and he fell sick. The
whole buttocks was rotten. In the ward where I was sleeping, you feel like
dying; he lay on the floor crying. This boy received no treatment. But the
smell was too much. After some time, we went to the OC’s office, and
said, “We are not going anywhere. We need our colleague to get
treatment.” The OC reached the door [of the ward], and smelled the
stench, and saw the flies. He said the man should get treatment. But even after
treatment, he still could not sit. He was totally rotten.[184]

Injuries from beatings at Kitalya Farm Prison were so common
that one inmate said, “there was a time from May to October last year
when the nurses here were no longer treating us for malaria, they were just
treating us for wounds on our buttocks from beating.”[185]
But treatment for these injuries is for many an unattainable luxury: only 15
percent of prisoners who told Human Rights Watch they had suffered a health
problem as a result of a beating had received treatment, and none of those at
former LAPs had received treatment. Matthew, a prisoner at Masafu, experienced
a beating so severe that his hand was broken, but the prison warden who beat
him would not allow him to go to the hospital.[186]

Isolation
Cells

Under Ugandan law, an OC may order a prisoner confined to a
separate cell for a period not exceeding 14 days on disciplinary grounds.[187]
The law explicitly states that “[s]tripping a prisoner naked, pouring
water in a cell of a prisoner, depriving him or her of food and administering
corporal punishment and torture is prohibited.”[188]

Yet, at 9 of the 16 prisons
visited,[189] Human Rights Watch researchers found that isolation cells
were used for punishment, sometimes in conjunction with each of the aggravating
factors specifically prohibited by law. Prison officers confirmed the
use of isolation cells, but denied the additional deprivations.[190]
At four prisons, Human Rights Watch researchers were
able to tour the cells used for prisoners’ isolation and found them to be
bare cement structures, with a bucket for a toilet, with sizes ranging from one
meter by one meter to four meters by five meters. At Luzira Upper Prison,
“never forget me” and “broken hands” had been etched
into the wall of one of the cells. Prisoners said that isolation can
range from a few hours to two weeks, as specified by law, but also noted that
it could last in some cases from months to a year[191]
depending on the prison and offence.

Despite the explicit legal prohibition, at many prisons a prisoner held in an isolation cell would likely also face
a combination of handcuffing, reduced food,
water poured on the ground to ankle depth,being stripped naked, and beatings. No toilets are typically available
in the cell, so prisoners use a bucket or even a paper bag for their excrement.
Esther described the conditions:

They completely undress you, and pour
water in there….It’s very cold in there because of the water. I
have been there. In the cell, there is something that retains the water and
there are so many mosquitoes breeding. The water is very cold, and your body
reacts badly. One woman was taken there on her period—she was undressed,
and she spent time in blood mixed with water.[192]

Being confined in an isolation cell, compounded with the
abuses described above, has a serious effect on inmates’ physical and
mental health. Inmates were described as “sick,”[193]
“not well,”[194]
“swollen,”[195]
“yellow and with a rash on their body,”[196]
with “burns,”[197]
“moving in a zigzag,”[198]
or “weak and can’t walk,” [199]
after they had been put in isolation and subjected to other abuses including
beatings. One prisoner at Luzira Upper said that he had seen three people die
there since 2005 as a result of beatings or mistreatment prior to or during
incarceration in the isolation cells,[200]
but the deaths could not be independently verified. Another prisoner reported
one inmate who had been confined to an isolation cell for two months began
cutting himself with a razor blade.[201]
“When they will take you to the cells, that’s when people
change,” concluded Abdul.[202]

The most fundamental protection for prisoners in
international and Ugandan[203]
law is the absolute prohibition on torture and cruel, inhuman or degrading
treatment. There is little doubt that the use of these cells to inflict
punishment constitutes prohibited inhuman and degrading treatment. Extended use
of these cells when combined with other punishments, such as handcuffing, being
stripped naked, food restrictions, and being made to stand ankle-deep in water,
constitutes a form of torture.[204]

Prisoners may also be confined in isolation cells (typically
without being stripped or forced to stand in water) not strictly as punishment,
but as a result of officers’ inability to appropriately handle and offer
treatment for their mental health problems. At Jinja Main Prison, researchers
found one prisoner with what a warden described as “mental
problems” occupying an isolation cell, who informed researchers that he
had “not been receiving medicine” and that he had not been seen by
a medical professional or offered any treatment.[205]
“We have an isolation cell for psychiatric cases or for those who have
failed to be disciplined,” admitted the deputy OC at Jinja Main. But, he
contended, “We base it on the medical staff to give us the right information.”[206]
Tumwesigye described a fellow prisoner at Jinja Main, “not a very stable
man,” confined in an isolation cell for a full year.[207]

Prevention
and Treatment of Disease

All people have a right to the highest attainable standard
of health,[208]
and under international law, states have an obligation to ensure medical care
for prisoners at least equivalent to that available to the general population.[209]
States also have an obligation to meet a certain minimum adequate
standard of prison health conditions and care to individuals in detention,
regardless of a state’s level of development.[210]
The Human Rights Committee, the monitoring body of the International Covenant
on Civil and Political Rights, has determined that danger to a detainee’s
health and life as a result of the spread of contagious disease and inadequate
care constitutes a violation of that treaty.[211]

Under Ugandan law, prisoners
are also entitled to “have access to the health services available in the
country without discrimination.”[212] The UPS acknowledges its legal responsibility to
ensure healthcare services equivalent to those available in the general
population.[213] Yet, the prison medical authority admitted that
equivalence does not currently exist.[214] HIV and TB, which occur at high rates in the prisons,
pose particular challenges. Incomplete and delayed reporting of health
conditions from prisons hinders the development of appropriately tailored
interventions for these and other health conditions.[215]

Tuberculosis

For TB, the rate is almost two, three,
five times the rate in the general community, depending on which region you
look at…. The prisoners enter, it makes them worse, it makes those who
haven’t come in with diseases acquire them. If we inappropriately handle
them—causing drug resistance, as for TB—we act as a petri dish,
then they just give it back to the community.

—Prison medical authority, Uganda
Prisons Service, November 18, 2010

Transmission

The conditions in Ugandan prisons—combining
overcrowding, frequent housing together of the sick and healthy, poor
ventilation, and lack of natural light—facilitate the transmission of
tuberculosis.[216]
“If one prisoner has Tuberculosis (TB) in a room filled with 50 inmates,
at the end of a day, everyone will be infected,” the commissioner general
of prisons has said, according to media reports.[217]

TB prevalence, already high in Uganda’s general
population, is significantly higher in the prison population. Uganda is ranked
16th of the World Health Organization’s 22 high-burden countries for TB
worldwide[218]
and in 2010 had a prevalence rate of 330 cases per 100,000 members of the
population.[219]
In 2008, the UPS and UN Office on Drugs and Crime (UNODC)
estimated that Ugandan prison TB prevalence was 654 cases per 100,000, almost
double national population prevalence.[220]

The Prisons Service acknowledges that TB education programs
thus far have been limited.[221]
However, the risk of contracting TB through the coughing of their fellow
inmates was not lost on many of the prisoners. As Johnson, a prisoner at
Bubukwanga who had coughed for the entire five months since he had been
detained, said, “I am sure I could be infecting other people. You see,
here we sleep in one room—sometimes 70 people, or 80. If you are sick,
definitely you will infect others. If they are also sick, they will infect
you.”[222]

Testing

We worry a lot when people are coughing
that we might catch the disease. No one has ever checked us for TB here.
Normally when the nurse comes and people complain about the cough, he says,
“I don’t have the gadgets to test you.” He gives you some
tablets and says, “Let’s see what will happen next.”

— Owen, Kitalya Farm Prison,
February 28, 2011

Regular TB screening is a well-established cornerstone of
prison health. Since 1993 the WHO has explicitly recognized the need for
“vigorous efforts” to detect TB cases through entry and regular
screenings in prisons.[223]
On Human Rights Watch’s visits to Ugandan prisons,
screening for TB was taking place only at a few of the reception centers located
near larger towns.[224]
The prison medical authority reported that entry screening had recently been
scaled up to 21 prisons from three original pilot sites,[225]
and he has plans to scale up entry screening for TB further.[226]
But he admitted: “We are wondering why we stayed too long to do that. The
findings are shocking.”[227]
Outside the major reception centers, TB screening for prisoners upon entry is
not taking place.

Twenty-eight percent of male prisoners and seven percent of
female prisoners interviewed by Human Rights Watch said that they had been
tested for TB during the period of their incarceration. Twenty-two percent
overall, the percentage of prisoners tested for TB varied between categories of
prison and fell to only 11 percent at former LAPs.

Just over one-third (36 percent) of prisoners interviewed
said that they had coughed for longer than two weeks since incarceration, but
nearly three quarters of these prisoners had not been tested for TB (28 percent
had been tested). Some of those prisoners who had been tested had never
received the result.[228]

Case detection rates for TB in the UPS are unknown,[229]
but it is widely acknowledged that infectious TB patients are not being
identified. The director of the national TB program speculated: “TB
missed? It must be big. Transmission in prisons may be 10 times higher than in
the general population. When you miss one, it is catastrophic.”[230]

Preliminary results from a recent
national drug resistance survey suggest that between one and two percent of TB
cases are multi-drug resistant (MDR-TB).[231] In the prisons, testing for drug resistance exists
only at Murchison Bay Hospital; the prison medical authority acknowledged that
drug-resistant cases undoubtedly exist but are not detected.[232]

Treatment

Uganda has been making progress in treating TB in the
general population, though significant gaps exist.[233]
Among the prison medical facilities, only Murchison Bay Hospital is accredited
to manage TB.[234]
Elsewhere, the prison medical authority envisions that TB suspects will be
transferred to regional prison health units, which will establish contact with
nearby public health facilities or, where there is no regional unit, will be
referred to the public health system. But as the prison medical authority
admitted, “It could be possible there are those not on treatment.”[235]

Inconsistent or incomplete
adherence to the eight-month treatment course risks creating drug resistance.
Saul was told by medical personnel at the public hospital to stop taking his TB
medication after two and a half months but was still coughing at the time of
his interview.[236] Prison authorities reported that at least three
prisoners died of TB in 2010.[237] Prisoners and prison officers at some prisons
reported that there were no medications for TB available at the prisons or at
nearby health centers for prisoners with TB.[238] As Gilbert at Kitalya Farm Prison noted, “The
nurses tell us there is no medicine, but there are quite a number of them
[prisoners] who do cough. I worry about it because those who are suffering from
TB, they are here. They are not isolated, and they receive no treatment.”[239]

The development of drug
resistance because of transfer to a farm prison, or upon release, is a major
concern of prison health officials.[240] The prison medical authority has noted that
inappropriate referrals to upcountry prison centers for hard labor of patients
on TB treatment risk creating drug-resistant TB.[241] While Ugandan law provides for prisoners under
medical treatment to be linked to medical or social services upon discharge,[242] and prison medical officers reported trying to make
efforts to link discharged TB patients to appropriate services, they noted that
those released from court and others were still released before finishing their
course of treatment without being linked to services near their homes.[243]

HIV/AIDS

When I told the prison officer I was
HIV-positive, he said, “Fight on, complete the sentence, go home, and get
treatment.” It meant he can’t do anything for me. There were
wardens I informed. They said prison has nothing to offer me.

—Robert, Masafu Prison, March 8,
2011

In 2009 Uganda had an adult HIV prevalence rate of 6.5
percent.[244]
Prevalence in Uganda’s prisons is even higher: a 2008 study found a general prevalence of HIV among prisoners of 11 percent.[245]
Yet human rights monitors have continuously found that prisoners have limited access
to HIV testing and treatment.[246]

Most frequently, prisoners reported that lack of food and
other basic necessities led inmates to trade sex for those items.[248]
Gilbert concluded: “The cause is the conditions. Some people will receive
visitors and be able to have something. They use the power of their resources
to entice others with doughnuts or sugar.”[249]
As Mukasa, at Luzira Upper, described, “These are the things that happen
in a closed environment. There is some homosexuality…. As a young man,
they give you tea, and you can end up giving in. They say, ‘You are now a
woman,’ once they get you.”[250]

Prisoners also said that rarely they had heard of instances
in which individuals were forced into sexual activity.[251]
Given the heavy stigma attached to same-sex sexual relations in
Uganda, according to Joshua, “Most of them negotiate. It’s very
difficult for someone to force. They will catch you and punish you.”[252]
Yet sexual coercion does occur. As one prisoner described, “Sometimes,
when you are sleeping together in the night, you will feel someone touching
you. Sometimes people are forced in the corridors during the day, but at night,
if someone touches you, you shout.”[253]

In addition to being subjected to caning or confinement in
isolation cells as punishment, prisoners
found to be engaging in sexual conduct with others, whether discrete consensual
acts or longer-term relationships, are subjected to sexual humiliation in some
prisons. According to Jacob:

Sometimes when people are caught having
sexual intercourse, they are put out in the field and made to walk around
naked. The chiefs in the wards help to identify them. If you are caught
red-handed, you are taken to the prison wardens. To try to control the
activities, they have undressed those who are caught, and have made them walk
around the [area surrounding the prison], to make them ashamed.[254]

International organizations—including WHO, UNODC, and
the Joint United Nations Programme on HIV/AIDS (UNAIDS)—all recommend
that condoms be provided to prisoners.[255]
Homosexual sex is illegal in Uganda.[256]
Its criminalization, itself a human rights violation, has the added result of
creating stigma and fueling transmission of HIV, particularly as it leads
prison authorities to deny condoms to inmates. UPS concludes that “notwithstanding
the existence of incontrovertible evidence of MSM [men who have sex with men],
the distribution of condoms to prisoners in custody is not possible….Exploring
the possibility of introducing condoms within the existing legal regime will
continue to be our priority.”[257]
According to the prison medical authority, “I know our interventions are
not as effective as we wish them to be—we are legally bound.”[258]

Testing

HIV testing has increased in some prisons in recent years,
and overall, 55 percent of prisoners interviewed who did not already know they
were HIV-positive when they entered prison reported having been tested for HIV
during their incarceration. A prisoner entrusted with medical authority at
Luzira Upper claimed that all new entrants are now offered HIV counseling and
testing.[259]
HIV testing at other prisons is offered in partnership with nongovernmental
organizations.[260]
Some prisoners also reported receiving diagnostic HIV testing at health centers
when allowed to go out to receive healthcare.[261]
More rural prisons, however, still lack completely both HIV screening upon
entry and diagnostic testing for those who fall ill. At former LAP prisons,
only 17 percent of the prisoners interviewed by Human Rights Watch had been
tested for HIV during their incarceration. The prisons service acknowledges
limited capacity for HIV testing because of inadequate staff, lab infrastructure,
and lack of motivation among counselors.[262]

Researchers heard reports that at those prisons conducting
HIV testing, some prisoners were subject to mandatory testing, as opposed to
the voluntary testing required by international best practice.[263]
Enid, at Luzira Women’s, said, “Whether, you want it or not,
you’re tested here.”[264]

Treatment

I’m positive. All the wardens are
aware. Even the OC is aware. I’m not getting medicine. I used to get
medicine. I left my medicine out there [outside of prison]. The warden beat me
so much, I even fear asking to go to the hospital. Since my arrest up to now,
I’ve not been taking my medicine.

- Matthew, Masafu Prison, March 8, 2011

Uganda has in recent years scaled up treatment, though
significant challenges remain.[265]
Estimates as to the number of prisoners receiving HIV treatment vary
significantly.[266]

In 2011 prison-based ART services
were only provided at Murchison Bay Hospital to residents of the
Luzira/Murchison Bay Prison complex in Kampala. HIV-positive prisoners at other
prisons were intended to access services at outside community clinics[267] or to be referred to a regional health facility (where
they would access services at public facilities) or to Murchison Bay. The
prison medical authority highlighted the HIV treatment gaps: “Upcountry,
we don’t have any prison health unit accredited for ARVs. If you are
positive and on antiretroviral drugs [when you come into prison], you would be
in trouble. There is no mechanism for you to get these supplies….We have
those who are positive. But no counselors, no access to public health
facilities. What do we do?”[268]

Table 5: HIV Treatment by Prison Type for
Prisoners Interviewed

Among prisoners interviewed, 18 (11 percent) self-identified
as HIV-positive. Of these, 22 percent were receiving no treatment of any kind,
and 50 percent were not receiving ART. The OC at Muduuma Prison confirmed that
the prison held HIV-positive prisoners, but they received no ART, as it was not
available at the nearby public facility.[269]
An HIV-positive prisoner at Muduuma reported:

We, the sick ones, remain in the wards,
and the OC comes to inspect. The only thing she does is to say not to go to
work….With the OC, I’ve raised the matter [of my HIV-positive
status and lack of medication] twice, but she doesn’t come inside the
ward, only peeps inside and says, “How are you?”[270]

Prisoners reported deaths of HIV-positive fellow prisoners as
a result of inconsistent or denied treatment.[271]
Prison authorities indicated that at least three prisoners died of HIV/AIDS in
2010.[272]
However Human Rights Watch was unable to verify claims of inmate deaths as a
result of denials or lack of medication.

Rural prisons did not always immediately transfer
HIV-positive prisoners to Murchison Bay. At Kitalya Farm Prison, seven
HIV-positive inmates were receiving only Septrin while awaiting transfer on the
day Human Rights Watch visited, but transfer was not immediate. Human Rights
Watch researchers saw at Kitalya referral forms of prisoners who had been
waiting for over a month to go to Murchison Bay.
[273]
At Muinaina, the OC reported that HIV-patients “in the early
stages” received Septrin and continued to work, while “when it gets
complicated, that’s when we have to take them to Murchison Bay,” but
acknowledged: “CD4 testing, it’s difficult to monitor.”
[274]
While some HIV-positive prisoners were transferred to Murchison Bay, they were
sometimes returned to their farm prisons, where treatment remained unavailable.

Even at Murchison Bay Hospital, medical staff reported that
due to inconsistency in the drug supply[275]
(ARVs come from the national medical stores), they are currently only starting
patients with a CD4 count less than 250 cells/mm3 on ART, rather
than following the national and international standard of less than 350
cells/mm3.[276]
The chief physician explained that if national guidelines were followed,
“so many would require it, it is not sustainable.”[277]

A high level of adherence is crucial for the success of ART.[278]
Lack of adherence can lead to the development of drug resistance, illness, or
death. But while many prisoners reported receiving their HIV medications
regularly, five HIV-positive prisoners interviewed said they had missed doses.
Reasons included drug stock-outs,[279]
lack of food,[280]
being prevented from going outside to access community-based care,[281]
or transfer between prisons.[282]
At times, prisoners share drugs to cover the shortfall.[283]

Gerard,
an HIV-Positive Patient Sent from a Rural Prison to Murchison Bay Prison
Hospital

I came in
when I knew I was HIV-positive. I had swellings on my elbows and legs, and
then I also feel paralyzed once in a while. By the time I was arrested, I was
using Septrin, and I didn’t get it. I spent three weeks at Sentema
[Prison], and there was no medicine.... They wanted me to go and dig—I
told them I was sick… they did not believe me. I showed them my swollen
fingers—they said, “We shall step on those fingers so they
heal.” I insisted, so they left me. The following day, the swelling
continued, and they realized—it was after two weeks when they took us
to a clinic outside the prison—they didn’t check me, but they
asked me which type of medicine I used. I said Septrin, and they gave me a
few tablets. But the following day, there was no medicine.

When I
stopped taking my medicine, that’s when I felt weak, and my body
started shutting down completely. I think they looked at me and thought I was
useless at their shambas [fields]; the kind of sickness I had would
not allow me to go and work. They decided to get rid of me. The OC at Sentema
saw me and I could not walk any more. He said I should be transferred to
Murchison Bay, and on that very day I was brought here.

When I
arrived here, on that very day I was taken to the hospital, and they admitted
me. They gave me some tablets—Septrin—they gave me Septrin that
very day. The following day, they checked me: They took my blood sample, told
me I was HIV-positive, and checked my CD4 count. They said it was very low,
180. They said they were going to put me on a different medicine, but I had
to wait, and they kept treating me. This month, they put me on ARVs—it
was after two months since they checked me, I don’t know why it was so
long. In the beginning, I did not feel very good, but now I’m getting
better.

I used to
move on crutches…but now I can walk on my own, and the body is no
longer so weak.

I have had
difficulty taking my medicine because of lack of food. The problem you get is
when you take the medicine, you feel it in your stomach. You would love to
eat, but you have to wait. It becomes problematic. Sometimes, I don’t
take it because of that. Sometimes, I force myself to because I have no
option—I want my life.[284]

Water- and Insect-Borne
Diseases

Malaria

Together with HIV and TB, malaria is one of the leading
causes of morbidity and mortality in Uganda’s general population.[285]
While national health guidelines call for malaria prevention through use of
methods including insecticide-treated nets and indoor residual spraying,[286]
such measures have not been adopted in prisons. In the prisons, bed nets are
not allowed for male inmates because prison authorities fear they could be used
as ropes or nooses,[287]
and even among female inmates interviewed by Human Rights Watch, only 29
percent said they had slept under a mosquito net on the preceding night.

Indoor spraying for mosquitoes has only been conducted by
the prison administration at three prisons, with help from the International
Committee of the Red Cross (ICRC),[288]
though even at one of the ICRC’s sites, on the day of Human Rights
Watch’s visit, researchers were informed that “the mosquitoes are
there because the spray is out of stock.”[289]
Prison officers elsewhere expressed a desire to spray for mosquitoes but had
not done so because they had not received spray.[290]
At some prisons, prison officers had attempted to put screens in the windows,
though prisoners sometimes pierced these to relieve the heat in the congested
wards.[291]
The prison medical authority said that the UPS had allocated 100 million Uganda
shillings (approximately $40,000) for FY 2010/2011 to fumigate and was
“working out a mechanism,” but distribution of spray had not taken
place.[292]

Prevalence is unmeasured but likely very high.[293]
Prison officers reported that malaria is common among prisoners[294]
and indeed is the most common ailment they observe.[295]
“When I came here, half the population was sick with malaria,” one
prison OC observed.[296]
Between the four-year period of FY 2005/06 to 2008/09, Uganda’s auditor
general calculated that 11 percent of deaths reported in Uganda’s prisons
were caused by malaria.[297]
As with TB, HIV-infected individuals are particularly vulnerable to malaria.[298]

However, treatment is frequently unavailable[299]
and capacity hampered by drug stock outs.[300]
Reported George, at Mutufu, “There are many who are suffering from
malaria. If you don’t have money [to buy your own medicine], you just
sleep in the ward and just keep there. The OC will tell you, ‘If you
don’t have money, you will die.’ You will not get the
medicine.”[301]

Hygiene-
and Sanitation-Related Illness

Poor water and sanitation also lead to the spread of
disease.[302]
Prisoners reported and statistics confirmed that they had seen cholera
outbreaks and frequent diarrhea.[303]
The UPS has determined that “diarrhea diseases are a major cause of
morbidity and mortality among prisoners” as a result of the continued use
of the bucket system at the majority of prisons.[304]

Skin diseases are also common. Throughout the prisons,
proper hygiene with limited government-provided soap is difficult, and lice and
scabies are rampant.[305]
Human Rights Watch regularly observed prisoners with significant
skin problems, scratching throughout interviews. Jonathan at Masaka Ssaza
Prison said, “There are so many lice…they say that the lice are the
security guards of the prison.”[306]
Prison medical officials accept that skin diseases are common.[307]
At Masaka Main Prison alone, which has a population of 630, a medical officer
reported seeing between 100 and 150 cases of skin infections a month.[308]
However, prisoners frequently reported skin diseases that had gone untreated.[309]

Non-Communicable Health
Conditions

Women’s
Health

In addition to experiencing the problems accessing care
faced by all inmates, women have a distinct set of healthcare needs and
challenges in detention.[310]
Women detainees benefit from special legal protections. Uganda
became a party to the Protocol to the African Charter on Human and
Peoples’ Rights on the Rights of Women in Africa (also known as the Maputo
Protocol) in July 2010.[311]
This provides that women in detention should be held in an environment
“suitable to their condition” and ensures their right to be treated
with dignity.[312]
International standards dictate that women in detention should receive
“special accommodation for all necessary prenatal and postnatal care and
treatment.”[313]
Yet as a minority in prison settings, women often receive little
attention.[314]

Female prisoners who were
pregnant or had given birth in prison reported that prenatal care was
frequently unavailable or inadequate. Christine, six months pregnant at Fort
Portal Women’s Prison, reported that she had asked daily to see a doctor
for the pain she was experiencing and blood in her urine but had been refused.[315] Lydia, six months pregnant, had received no prenatal
care for the month and a half she had been in prison.[316] Women at Luzira Women’s receive prenatal
services at the staff clinic, the only prison-based facility offering delivery
services (Murchison Bay Hospital is all-male);[317] but even there, female prisoners claimed that care
was inadequate.[318] Postnatal care is minimal: Grace said she was forced
to return to the prison two hours after giving birth at a hospital.[319] For women who are not pregnant, gynecological care is
unheard of.

HIV testing for pregnant
women suffered from numerous problems. Pregnant women reported
“mandatory” testing in some instances.[320] In others, testing was either not offered[321] or the results were not shared with the woman who had
been tested.[322] Prevention of mother-to-child transmission of HIV is
available only through prison health services from the Murchison Bay staff
clinic; or “if the situation allows, she can access the public health
facility.”[323] The WHO protocol for PMTCT notes that even among
HIV-infected pregnant women who do not require ART for their own healthcare,
“ARV prophylaxis should be started from as early as 14 weeks
gestation.”[324] Yet some HIV-positive pregnant inmates described
treatment in violation of WHO guidelines. Hellene, a 16 year-old who was six
months pregnant, reported: “After the [HIV] testing, they told me I was
positive.… I have no ARVs. They give me panadol, Septrin.…PMTCT?
They have never discussed with me.”[325]

Pregnant inmates—nearly all of whom said that they
were forced to work in the fields—also have their health particularly
impacted by hard labor conditions and abusive punishments.[326]
At Fort Portal Women’s Prison, two female inmates separately described an
incident in which a fellow inmate had a miscarriage at eight months pregnant, a
result they believed of her forced hard labor and denial of healthcare.[327]
Overall, 30 percent of female inmates interviewed by Human Rights Watch said
they had been beaten, including eight pregnant inmates.[328]
Hellene, the 16 year-old remandee at Butuntumura Prison who was six months
pregnant, described being beaten in the stomach by a warden while digging,
necessitating a trip to the hospital.[329]
Mary, at Jinja Women’s Prison, reported being beaten and kicked while
seven months pregnant, also leading to a hospital visit.[330]

Mental
Health

Before coming in [to prison]...I was
taken to Butabika dispensary mental health center, some time long ago. I was
given a dosage, I was admitted. The doctors were coming to see me. [Now] no one
is taking me back. At Butabika, very much good for my body, the drugs.... My
spirit tells me to move to Butabika. I should walk to Butabika. That hospital
is different from this one here. My spirit is telling me to go.

—Mutebi, Muduuma Prison, November
12, 2010

Ugandan criminal law exempts anyone with “any disease
affecting his or her mind incapable of understanding what he or she is doing or
of knowing that he or she ought not to do the act or make the omission”
from criminal liability.[331]
Courts may order accused people to undergo psychiatric assessments to ascertain
competency to stand trial,[332]
but there is a backlog of prisoners awaiting these determinations.[333]
The prison medical authority admitted, “We are mindful we are flouting
existing regulations of not having the mentally sick.”[334]

Human Rights Watch found that inmates who could not answer
basic questions about their charges, length of incarceration, or age were
undergoing criminal prosecution with no legal representation.[335]
Additionally researchers found 11 inmates detained indefinitely awaiting action
from the Minister of Justice following a ruling of not guilty by reason of
insanity.[336]

Nationally, UPS estimates
that five percent of prisoners have “mental problems” upon entry.[337] Prisoners and prison officers described that inmates
also develop mental health problems following entry into prison.[338] UPS attributes the high burden of mental health
problems in prison to a combination of “the association between substance
abuse and criminality” and the “high psychological and emotional
stress” associated with incarceration.[339] The president of the Uganda Medical Association, a
psychiatrist who has previously provided mental health services at Murchison
Bay, noted that mental health problems are very prevalent in the prisons, particularly
anxiety and depression, as a result of mistreatment upon arrest and the
“mental torture” of long remand periods.[340] Prison statistics indicated at least two deaths by
suicide in 2010.[341]

At upcountry facilities,
mental healthcare is almost nonexistent and, if it exists, is dispensed by the
prison OC, a position with no medical training.[342] Prisoners repeatedly described receiving no or
inadequate mental healthcare themselves or for their fellow prisoners. “Many get
lost. Forget about upcountry, there’s nothing going on up there [in rural
facilities],” concluded the president of the medical association.[343]

Prison officers outside of
the major regional centers or Kampala by policy are supposed to send serious
cases of mental health problems to regional units or Murchison Bay for
treatment or analysis of competence to stand trial.[344] Over 140 prisoners at the Luzira prison complex are
diagnosed with some form of mental health problem, including those with
schizophrenia and severe mental disabilities who “have stayed for years
in prison.”[345] But even at Murchison Bay and at regional centers,
mental health services were grossly inadequate.[346] Treatment based entirely on provision of medication,
without any psychotherapy or alternative mental healthcare, was inferior to
that available at the public mental facility, Butabika.[347]

III. Addressing the Causes of Poor Health in
Uganda’s Prisons

Criminal Justice Failures

Prolonged Pretrial Detention

Last time I was in court was October
31, 2002, when I was committed…. Can you help me find my way to court?

—Edward, a prisoner awaiting
resolution of his case for almost nine years, Muinaina Farm Prison, March 4,
2011

The heavy backlog in the
criminal justice system results in overcrowding in prisons,[348] and prolonged periods of time on remand have adverse
effects on prisoner health. Despite international legal requirements that pretrial
detention be “an exception and as short as possible,”[349]
in Uganda, suspects may wait in prison for years for their trials to be
resolved. Fifty-six percent of all inmates are on remand, incarcerated awaiting
resolution of their case.[350]
The average wait is estimated at one year and three months for capital offences,
such as defilement,[351]
murder, aggravated robbery, rape, and treason.[352]
The average wait for lesser offences, such as assault and theft, is three
months.[353]

Table 6: Months in Detention for Remand
Prisoners Interviewed

As a first step upon arrest,
international and regional law provide for the right to be brought before a
judge, and to be charged or released.[354] Under Ugandan law, a suspect must be charged by a
court within 48 hours of arrest.[355] Yet, 85 percent of prisoners interviewed by Human
Rights Watch had not been brought before a court for an initial appearance
within 48 hours, and prisoners reported having waited significantly longer.[356]

Table 7: Interviewed Prisoners’
Appearance before a Judge or Magistrate

Human Rights Watch
researchers spoke to seven individuals who had been awaiting resolution of
their cases for over five years,[357] and seven prisoners who said they had not set foot in
a courtroom in over two years.[358] The remand prisoners that Human Rights Watch
interviewed had been awaiting resolution of their cases for a median of five
months and mean of 15 months. Prisoners find themselves in a position of
deciding whether it will be faster to plead guilty and serve a sentence than to
plead not guilty and await trial, later to be found innocent. Several described
pleading guilty in order to hasten their release.[359]

Long remand times result from
several problems within the judicial system, all of which contribute to large
prison populations.[360] An insufficient number of judges has led to too few
court sessions.[361] In Mubende district, where the High Court sits for
only two months a year, the lack of a High Court judge has led to average
remand periods of five years at Muinaina Prison.[362] Despite constitutional guarantees of a speedy trial,[363] prisoners languish in detention for long after their
cases have been committed to the High Court for trial before any trial begins,[364] and partially heard trials continue indefinitely
without complainants or witnesses appearing in court. Prisoners said their
trials adjourned repeatedly without any progress.[365] Ekanya said, “I have been to court 16
times…. There is no evidence during trial. The complainant hasn’t
come to court. I stand up, then they say go back. Then they say come back on
such-and-such a date.”[366] Civilian cases in the military court system trying
gun crimes—in itself a violation of international law—progress
particularly slowly, given the court’s few sessions.[367]

The Justice Law and Order Sector (JLOS), a group of government
bodies including the judiciary, police, prisons, prosecution, Uganda Human
Rights Commission, Ministry of Justice and Constitutional Affairs, Ministry of
Internal Affairs, and international donors, has been concentrating its efforts
through a “Case Backlog Quick Wins” project to reduce the case
backlog, particularly by weeding out non-meritorious cases lacking evidence
during investigations, appointing more judges, and holding more court sessions,
resulting in the clearing of 80,000 cases between March 2010 and March 2011.[368] However, the number of new
cases continues to outpace the clearing of old ones, and the backlog continues
to grow at 8.5 percent per year.[369]

While
the Ugandan constitution provides for a right to bail, few defendants have the
opportunity to request bail, increasing the burden on the prison system.[370] In non-capital cases,
suspects can represent themselves and orally request bail at magistrate’s
court.[371] Suspects in serious cases,
meanwhile, can be detained for an indeterminate period of time until their case
is sent, or “committed,” to the High Court for trial.[372] During this time,
defendants who are unable to afford a private lawyer are effectively prevented
from exercising their right to bail because they are brought before a
magistrate’s court first, which does not have jurisdiction over the case
and therefore cannot hear a bail application. A suspect can apply for bail
before the High Court, a complex process often requiring legal help which is
prohibitively expensive for most defendants.[373] However, it must be noted
that a recent proposal by Ugandan President Museveni, if enacted, would amend
the constitution to eliminate bail entirely for suspects accused of crimes
including rioting and economic sabotage, in addition to rape and murder.[374]

Only six percent of all prisoners
interviewed by Human Rights Watch had ever been released on bail. Seventy-four
percent of prisoners interviewed said that they were never offered bail.
Eighteen percent said that they were given the option of bail but were unable
to afford cash bonds or to post sureties.[375]

Judges also interpret the
constitutional provisions on bail as allowing them to impose a mandatory period of detention on remand before bail
applications can be heard.[376] Numerous prisoners told Human Rights Watch that magistrates
had informed them they were not entitled to apply for bail until they served a
minimum period of time on remand.[377] One prisoner who had been on remand for a year and
four months was told he had not spent enough time on remand to qualify for
bail.[378] Prisoners complained of corruption in the bail
system, either through the payment of bail money which did not result in bail
or which was never returned to them.[379]

A
lack of legal representation also contributes to prison congestion. For serious
offences punishable by death or life imprisonment, the state must provide legal
representation in courts (referred to as “state brief” lawyers).[380] However, Ugandan law does
not specifically stipulate when in the process the right adheres, and in
practice suspects rarely meet with their lawyers until the commencement of
trial.[381] A handful of nongovernmental
organizations provide legal advice in prisons, but their reach is usually
constrained to large prisons near larger towns.[382] JLOS’s development
partners have found “most disappointing…the continued delays in the
development of a legal aid policy.”[383]

Without lawyers, individuals
are unable to advocate for bail, request dismissal on the basis of lack of
evidence or advocate for a reduced or non-custodial sentence.[384] International standards mandate that people who are
charged with a criminal offence be informed of their right to have access to a
lawyer.[385]
However, only 21 percent of
defendants interviewed by Human Rights Watch had been represented by a lawyer.
More than three quarters (79 percent) of prisoners who ever had a lawyer had
been represented by a government state brief lawyer, and those who did have a
state brief lawyer only met the lawyer at trial. Prisoners often said they
tried to speak for themselves in court, only to be told by the judge or
magistrate they were not allowed to do so.[386]

Corruption
in the criminal justice system, particularly bribery and extraction of fees for
free services, is reportedly widespread,[387] leading JLOS’s
development partners to state they were “disappointed by the lack of
meaningful progress in implementing a sector anti-corruption strategy.”[388] Numerous prisoners told
stories of rampant corruption throughout the justice system, starting from the
time of arrest through trial, eroding their trust in the system to process
their cases with good faith or any measure of speed.[389]

Unnecessary and extended pretrial
detention imposes significant financial costs on the government, and savings
could be generated by increasing the option of bail instead of pretrial
detention, freeing up money for crucial social services.[390]

Detention Following Conviction

For defendants who have been
convicted of some lesser crimes, community service as a non-custodial option
exists, and, in 2010, 11,000 cases were granted community service options.[391]
JLOS reported that “[t]he public now support community service as
punishment and appreciate its impact in reducing the rates of
recidivism.”[392]
However, the commissioner of community service stated that the success of his
program depended heavily on “the personality of the magistrate” and
his or her willingness to use it as a sentencing option.[393]
Two prisoners told Human Rights Watch that they were advised by a member of the
community service program to plead guilty and ask for the option, only to be
later sentenced to prison time instead, when the prosecution and magistrate
failed to agree.[394]
Hassan said,

After some hundred days, while I was
appearing in court, someone came in and advised me that if I accept the case,
the sentence will be minimized with a community service agreement. It was a
lady from a project related to community service….I admitted, was
sentenced, but later realized I had made a mistake because I did not do the
crime. That lady talked to all of us, but I was the first to appear. When I was
sentenced, the others refused to say they were guilty. She was not a lawyer,
but she had assisted others who were being released. She told us she had talked
to the magistrate, perused our files, and was conversant with the case and the
evidence.[395]

For prisoners who have been convicted and sentenced to a
custodial term, there is no parole system in Uganda.[396]

Under international law, everyone convicted of a crime has
the right to have his conviction and sentence reviewed by a higher tribunal
according to law.[397]
However, numerous prisoners described filing an appeal and hearing nothing in
response, despite waiting for years.[398]
A paralegal working with prisoners said, “No response to
appeal?—that’s just a lack of follow up. People with money to get
legal representation get justice.”[399]

Detention of Children

Sometimes, children are also
detained with adults in Ugandan prisons. Human Rights Watch found six people
who said they were children currently being detained with adults in three
different prisons, in addition to four young adults who said they had been
detained in adult prisons since they were under 18.[400] Detention of children with adults is prohibited under
Ugandan and international law[401] and carries severe risks for children, including the
potential for violence and sexual abuse.

Determining a child’s age is not a straightforward
matter in Uganda. Fewer than four percent of children have a birth certificate
despite the state’s obligation to register births.[402]
Ascertaining age is an arbitrary process, either based on appearance or
inspection of teeth. Because of the logistical difficulties in handling
children, police often inflate their ages.[403] Only one of the children interviewed by Human Rights
Watch was ever given the opportunity to present evidence of her age.[404] When Human Rights Watch raised concerns about the
ages of two prisoners remanded at Bubukwanga Prison with the magistrate, the
children were released when they were produced before court, which agreed that
they were under age 18.

Prisons Service Failures of
Management and Health Services

The Role of Prison Officers in Denying and Delaying Care

When you want to go to the hospital,
you tell the wardress. But for the time I have been here, I have never seen any
person taken to hospital. It is so close, but the wardress just gives us
panadol. When you tell them you want to go to hospital, they just beat you.
They say, “Is this a hospital?”

—Nathan, November 12, Muduuma
Prison, 2010

Prison wardens and officers in charge play a direct role in
denying or delaying prisoners’ access to appropriate medical care.

Ugandan law provides that the OC, on the advice of the
medical officer, may order a prisoner to a hospital.[405]
As of March 2011, only 63 of Uganda’s 223 prisons had any on-site healthcare
worker, covering an estimated 17,741 prisoners at upcountry units and 4,500 at
the Luzira complex.[406]
But for those at prisons without medical facilities or for those with more
serious ailments that could not be dealt with at their prison health unit,
prisoners across facilities repeatedly described that prison wardens act as
gatekeepers. Wardens denied or delayed inmates’ access to community medical
facilities because of suspicions that prisoners were using ill health as an
excuse not to engage in forced labor, as a pretext for escape,[407]
or for more malicious motivations: Mary, a pregnant inmate at Jinja
Women’s Prison, was not allowed to return to the doctor after the doctor
told wardens that their beating had “dislocated her pregnancy.”[408]

Delays sometimes last up to a
month[409] before wardens will accompany a prisoner to care and
at some prisons, access to outside facilities was denied entirely.[410] The prison medical authority acknowledged: “It
is so amazing, a health facility which could be 100 meters away from a prison
is not accessed by the prisoners. Those things happen. Some of them, it is a
lack of responsibility. Why should you deny me to walk 100 meters away?”[411]

In practice, even when medical personnel are present at the
prison and do recommend that a prisoner be allowed out to access medical care,
a non-medical officer may well override the recommendation of his or her
medical colleagues. A medical officer told Human Rights Watch that at the time
of the year when Ramadan and Christmas are being celebrated, the escape rate is
higher and “they [the wardens] argue with us to reduce the rate of
referral.”[412]
The prison medical authority admits that there is little integration between
medical and non-medical workers and a “lack of sense of ownership of the
responsibility and mandate over healthcare issues” exists on the part of
OCs.[413]

Prisoners reported that in
the time they had waited for medical care, their conditions had deteriorated
significantly. Esther said her baby’s fingers had to be amputated because
of the delay in allowing her go to the nearby hospital.[414] Prisoners even claimed that deaths occurred as a
result of delayed access to outside facilities, claims that could not be
independently verified by Human Rights Watch. At Masaka Main Prison, prisoners
reported the recent death of an HIV-positive prisoner who had requested care
and was taken to the prison-based clinic, only to be refused access to the community
hospital and taken back to the ward, where he died.[415] As Peter recounted:

He spent the whole day requesting to go
to hospital. He said if he was to die, let him die in hospital. But the guards
refused to take him. They knew he was suffering from HIV. Late in the evening,
they locked us in the wards. A few minutes later, [he] fell and died. The
guards were saying, “You’re afraid of going to court, so you want
to go to hospital and escape from there.”[416]

The prison death register
confirmed the death in September 2010 from “HIV stage 4 with
psychosis” with the cause of death listed as “multiple organ
failure.”[417]

Prisoners falling seriously
ill in the night are sometimes denied immediate access to care, and have to
wait until the following day,[418] including female prisoners experiencing labor pains
at night.
[419] Inmates reported that, during the nighttime, they had
seen their colleagues die,[420]
claims Human Rights Watch could
not fully verify. Mafabi, at Butuntumura Prison, said: “In
September, there was a prisoner who died in full view. He fell sick at night,
and we called the wardens, who said ‘wait until tomorrow.’ During
morning parade, they carried him out and put him on the ground.”[421]
Inmates forced to watch their fellow prisoners
suffer in the night said that they tried to treat them with whatever
medications they had available.[422]

Prisoners were sometimes not allowed to receive medicines
purchased by family and friends on the outside, even when the prison was unable
to provide them with appropriate medications.[423]
The prison medical authority claims that prisoners are allowed to bring in
drugs if the health workers are in contact with their relatives. However, where
there are no health workers, “I don’t know what happens
there.”[424]

Prisoners with serious
ailments also reported they have been denied or delayed access to Murchison Bay
or regional prison health referral facilities. Prisoners reported that they or
their colleagues waited up to six months[425] for transfer. While admittedly transport
unavailability is a challenge,[426]
upcountry officers’ incompetence or malice in delaying or denying
referrals to prison referral facilities are also to blame for the poor health
outcomes.[427]
During the time waiting for transfer, a prisoner
reported that his head was oozing pus,[428] another that his skin was “peeling off,”[429] another that he was in such terrible pain he was not
able to sleep or eat properly,[430] and another that he was unable to walk or move.[431] Medical workers confirmed that in some cases
delayed referrals lead to death on arrival at Murchison Bay: “Absolutely
we have had delays…and when they occur, they are inappropriate. When he
reaches here, and is declared dead, it is not a surprise.”[432]

Once ill prisoners have
reached a facility where they can receive treatment, though, they cannot rely
on or expect continuous or consistent access to it. It is common practice to
transfer sick inmates to upcountry prisons despite there being no healthcare
facilities. Coordinating the transfer of prisoners is the mandate of recipient
OCs—at Murchison Bay or regional centers—to ease congestion or
facilitate work, and is conducted without consultation of trained health
workers. The prison medical
authority concluded, “You end up
having sick people transferred from a facility that offers service to the
prisoners for years to an area without. How inhuman can you be?”[433]

Failures in the Delivery of
Prison Health Services

To its credit, the UPS has made a marked effort to improve
prison medical care in recent years, particularly at the large facilities in regional
centers. Yet major gaps remain. At rural, former local administration prisons,
often no medical care is available. The deputy OC at Bubukwanga Prison said the
prison had no medical staff, no medicines, and no idea who was sick.[434]
A medical officer at Masaka Prison noted that, while regional units had
supervisory duties over lower units, because of limited funds, “those
that are far, we don’t go there. In the faraway units, healthcare is
poor.”[435]
Only panadol and other basic painkillers, dispensed by the officers, were
sometimes available (but quickly exhausted[436]).

Even at prisons with associated medical facilities,
obtaining care is far from a sure thing. Health infrastructure at most clinics
is “dilapidated” or “make shift” and aside from
Murchison Bay, only three of ten regional referral health units even have lab
services.[437]
X-ray and CD4 count facilities are currently lacking at the regional level,[438]
and Murchison Bay lacks an adequate operating theater.[439]

Adequate staffing is a major challenge. At all facility
levels, though significant improvements have been made,[440]
human resources for health fall far short of the prisons service’s stated
needs.[441]
UPS employs only six physicians (none of them at upcountry units).[442]
Prisoners contend that health staff frequently do not see those who come to
them for treatment.[443]
Ali, at Murchison Bay Prison, lamented, “The doctors are nowhere to be
seen.”[444]

Prisoners at prisons with associated health units told Human
Rights Watch that the medicines they needed were frequently unavailable[445]
or only partially provided.[446]
“You get half-treatment,” Yusuf, at Murchison Bay, concluded.[447]
Prison authorities confirmed that problems remain
with inadequate access to medications for prisoners, particularly in prisons
outside of Kampala.[448] UPS has concluded that the number of health units
reporting stock outs of essential medications remains high for reasons
including low per capita expenditure.[449]
Access to supplies at upcountry medical units from the national drug stores via
neighboring Ministry of Health facilities has also “failed.”[450]
Uganda’s auditor general has concluded that UPS provision of free medical
services to non-prisoners in neighboring communities has a significant negative
effect on the resources available for prison health and should be halted.[451]

Funding for referral services is also inadequate.[452]
Some prisoners said that, despite the fact that all medical services are to be
offered free of charge,[453]
when they are taken to Mulago public hospital in Kampala for specialized
medical care they are asked for money and denied treatment when unable to pay.[454]
The OC at Murchison Bay acknowledged delays in prisoner treatment at Mulago
because of the process for funding approval: “By the time they are worked
on, it is not even meaningful.”[455]

Donor Funding to Ugandan Health and Prisons

Uganda is a recipient of significant international donor
aid, particularly for health. In 2009, Uganda received over US$1.7 billion in
bilateral and multilateral donor aid.[456]
Health-related, and particularly HIV-related, donor funding to Uganda has been
led by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). In
FY2010, PEPFAR gave over $280 million to Uganda for AIDS relief,[457]
with disbursements from 2004 to July 2010 totaling $1.4 billion.[458]
The United States (US) contributes approximately 70 percent of all funding for
HIV/AIDS activities in Uganda.[459]
In 2007, 93 percent of Uganda’s funding for HIV came from international
bilaterals; in 2008 they contributed 83 percent.[460]

However, little funding has been donated to prisons. Total
donor funding between FY 2005/06 and FY 2008/09 for UPS fell from 2.11 billion
shillings (approximately $875,000) to 0.72 (approximately $300,000), just 1.5
percent of the total prison budget for that year.[461]

While some donor initiatives have been executed or planned
for health in Ugandan prisons, their scope is minimal compared to overall
health funding to Uganda and given the high rates of HIV and TB infection among
the prison population. According to Uganda AIDS Commission estimates,
approximately $28 million would have been required to fund comprehensive
HIV/AIDS interventions in Uganda Prisons and Police Services from 2007/2008 to 2011/2012;
however, actual contributions from external partners totaled only one percent
of this amount, and pledges approximately 10 percent.[462]
Prison authorities have noted the need for increased funding to fight both HIV
and TB.[463]

Officially, UPS’ health division has a number of
partners,[464]
but undoubtedly the largest monetary contributors are the International Committee
of the Red Cross and the U.S. Centers for Disease Control and Prevention (CDC)/PEPFAR.
The ICRC has helped to improve water and sanitation and has upgraded HIV, TB,
and malaria services at Fort Portal, Luzira Upper, and Gulu Prisons;[465]
their support has been extended for two years at $70,000 per year.[466]
The CDC has made a five-year commitment to the prisons, between 2009 and 2014,
of US$1.6 million, but less than half of the money from the first two years has
been absorbed by the UPS because of a delay in the process of creating the
prevalence and risk behavior survey on which interventions will be based.[467]
Between the ICRC and CDC projects, the UPS should, in theory, receive monetary
donor contributions of $390,000 for health over the government-provided budget.[468]

IV. Recommendations

We need resources. But it would be
unfair on my part to really stand up and complain we can’t improve the
situation because there are no resources. There are many things we can do
without resources.

—Prison medical authority, Uganda
Prisons Service, March 11, 2011

Improving
health in Ugandan prisons will require significant changes on the part of the
Uganda Prisons Service, and will also require improved coordinated efforts of
the Ugandan government, civil society, and international agencies and donors.
Some reforms are resource-neutral; those that are not are crucial to the
realization of the rights of prisoners and are the responsibility of both the
national government and international donors.

To the President of
Uganda

Issue direct orders to the UPS to stop the
use of compulsory prison labor by private landowners or prison authorities and
to halt the use of abusive punishments

Order an independent inquiry into corruption
and use of compulsory labor in the UPS and hold those responsible for the
illegal use of forced prison labor accountable

To the Uganda Prisons
Service and Ministry of Internal Affairs

Immediately:

Issue direct orders to stop the use of compulsory
prison labor for private landowners and prison authorities

Investigate and demand accountability for
funds raised through prison labor

Preventing labor for any private entities,
whether by convicts or remands, unless with their consent and with fair
remuneration

Providing male convicts between 18 and 45
engaging in prison labor with terms similar to those free laborers receive in
terms of hours worked, conditions of work, and remuneration

Reform prisoner disciplinary systems by:

Declaring a zero tolerance policy on the
beating of prisoners effective immediately and warning that officers and
inmates judged to have inflicted corporal punishment will be prosecuted and
punished

Discontinuing the practice of stripping
inmates naked, handcuffing, beating, or holding them in water while in
isolation confinement and punish officers found to have engaged in such
practices

Ensuring detainees are able to send
confidential complaints to the Uganda Human Rights Commission and other
organizations and that all prison officials are aware of this right and do not
interfere with it

Investigating all complaints of abuse against
inmates suspected of or charged with same-sex sexual conduct and taking
appropriate action against those found responsible for such abuse

Carry out
regular monitoring visits led by headquarters and medical staff, with better
defined indicators and targets for prison inspectorate monitors, to ensure the
health and well-being of prisoners throughout the country and a halt to corrupt
labor practices

Ensure that conditions of confinement meet
international standards, including by taking immediate action to improve basic
prison conditions by:

Providing food of improved nutritional
content, including rations for children, and additional rations for pregnant
prisoners; prisoners with HIV, tuberculosis, and other health conditions
requiring nutritional supplements; and inmates engaging in hard labor

Instructing all OCs to accept primary
responsibility for inmate health, including facilitating inmates’ access
to community or prison referral health facilities, with disciplinary penalties
for failure to do so

Creating guidelines to ensure that inmates
receive health screenings prior to transfer to rural prisons and that ill
inmates are not transferred to prisons lacking adequate healthcare facilities

Providing HIV prevention, treatment, and
care education, including information and sensitization on harm reduction and
safer-sex practices in the context of same-sex sexual conduct at each prison to
increase condom acceptance

Creating guidelines on mental health
evaluation and care for the prison system, and the transfer of inmates in need
of mental health evaluation or treatment to prisons with such capacity

Making mental health services available on
the basis of free and informed consent

Seek and allocate funding for the prison
budget to ensure conditions consistent with international standards, without reliance
on income from private landowners

As more resources become available:

Address prison health by:

Establishing the presence of a trained
health worker at each prison, with a minimum consistent supply of essential
medications and the capacity to conduct TB and HIV testing and who can evaluate
prisoner health complaints, including women’s, and facilitate access to
prison referral or community hospital facilities

Conducting health screening of all prisoners
upon entry and at regular intervals

Establishing TB and HIV treatment capacity
and accreditation at a minimum at each regional referral unit

Implementing HIV voluntary counseling and
testing for pregnant inmates as part of a comprehensive system of prenatal
care, offering prevention of mother-to-child transmission of HIV where
appropriate

To the Ugandan
Parliament and Ministry of Finance

Allot sufficient funding for the budget for
Ugandan prisons to ensure conditions consistent with international standards
without reliance on the income generated by the forced labor of unconvicted or
physically unfit inmates

To the Ugandan
Judiciary and Ministry of Justice

Address corruption and bribery in the system
by requiring bail hearings to be conducted in open court instead of in
camera

The Rules Committee should
issue a Practice Direction for bail with conditions and guidelines for
reasonable bail amounts, given income levels in Uganda

Instruct judges that the constitution
guarantees bail after 60 days for non-capital offences and 180 days for capital
offences and that there is no minimum amount of time required for prisoners to
remain on remand before they are eligible for bail

Sensitize judges to the benefits of
community service options and assure prisoners through agreement with
prosecutors and magistrates that their decision to plead guilty on
consideration of a promise of community service will actually result in
community service sentences

Establish guidelines on time limits within
which partially heard trials must be resolved or dismissed due to failure of
witnesses or complainants to appear

For defendants who claim to be under 18,
request and accept evidence of age and do not order detention of children with
adults

Devise a functional legal aid system to
ensure that defendants have access to a lawyer, provided by the state if they
cannot afford one, from the time of arrest

Issue guidelines on police bond and track
the implementation of these guidelines

To International
Agencies, Donors, and Nongovernmental Organizations

Continue funding efforts to reduce the case
backlog, with emphasis placed on appropriate legal assistance, more judges, and
more sessions

In the short term, ensure the direct
delivery of health service provision in prisons including TB and HIV testing
and treatment programs; women’s health; and mental healthcare programs on
the basis of free and informed consent

In conjunction with any current or future
funding to the UPS, set clear preconditions for funding including that:

Reliance on income from forced labor as
currently implemented is halted, as are beatings and physical abuse

Prison OCs need to take responsibility for
prison health and stop denying prisoners access to care at community- or
prison-based medical facilities

Prisoners with confirmed disease need to be
transferred to and kept at facilities where they can receive treatment

In the long term, support the scaling up of
the prison medical directorate to provide each of the services detailed above

Develop community reintegration programs, halfway
houses, and microfinance initiatives to assist prisoners with reentry and
decrease the risk of recidivism

Acknowledgements

This report was researched and written by
Katherine Wiltenburg Todrys, researcher in the Health and Human Rights
division, and Soo-Ryun Kwon, consultant in the Africa division. Maria Burnett,
senior researcher in the Africa division, edited the report and contributed to
the research. Joseph Amon, director of the Health and Human Rights division,
edited the report and contributed to the research design.

Mignon Lamia, consultant in the Health and
Human Rights division, assisted with data entry and analysis. Alex Gertner,
associate in the Health and Human Rights Division, provided editing and production
assistance. Grace Choi, publications director, and Fitzroy Hepkins, mail
manager, provided production assistance. Giulio Frigieri, consultant, created
and designed the map.

Human Rights Watch would like to thank all
of the individuals who agreed to be interviewed for this report. Human Rights
Watch is particularly grateful to the Uganda Prisons Service for its
transparency and to the prisoners and prison officers whom its researchers met
and interviewed, without whom this report would not have been possible.

Appendix

April 8,
2011

Dr. J.O.R. Byabashaija
Commissioner General of Prisons

Uganda
Prisons Service

Plot 13/15
Parliament Avenue

P.O. Box
7182

Kampala,
Uganda

Dear Dr. Byabashaija,

I am writing to you to
request information related to Uganda’s prisons.

As you know,
Human Rights Watch conducts monitoring and reporting on human rights issues
globally. The Health and Human Rights Division, which I lead, has, over the
past decade, worked in more than two dozen countries globally, examining such
issues as HIV/AIDS, TB, drug abuse, mental health, and access to health care
for migrants, prisoners, and indigent populations.

With your
permission, Human Rights Watch has recently conducted visits to 16 prisons as
part of our on-going monitoring of the criminal justice system. We are grateful
for your willingness to allow these visits and for the dialogue our Uganda
researcher, Maria Burnett, has enjoyed with you in the past on detention
issues. We look forward to continuing this dialogue in the future. I
write today to seek your response to a number of concerns arising from these
visits that relate to the health and human rights of prisoners, so that we can
ensure that your views are reflected in an upcoming report on these issues.

Conditions vary
greatly from prison to prison, and significant improvements have been made in
improving conditions and health care in some prisons in recent years. However,
some Ugandan prisons suffer from overcrowding and inadequate food, water, and
sanitation. Some prisons lack medical facilities, and prisoners may be
prevented from accessing community-based or prison referral facility medical
care by the determinations of non-medical officers and because they are forced
to work.

Prisoners, and some prison officials,
told us that convicted and unconvicted prisoners are forced to work without pay
on prison officers’ and private fields; prisoners frequently reported
canings, and isolation cell use, sometimes coupled with water on the floor, denials
of food, and beatings.

Your response to the following
inquiries would be greatly appreciated.

Please
provide us with relevant Uganda Prisons Service (UPS) policies on inmate labor
and on disciplinary offenses and appropriate punishment for
prisoners.

Are UPS
officers permitted to use prison labor to work on their privately owned
land or hire them out to other private landowners? If so, which categories
of prisoners are eligible for such work and what oversight is provided by
the UPS?

Please
specify how many officers in charge have been disciplined for infractions
over the past year, what type of infractions each was charged with, and
what disciplinary punishment was imposed.

Please
provide us with information on injuries and deaths of prisoners in custody
for the past year, including the cause of injury or death, for each
prison.

Please
provide us with data on the number of prisoners punished monthly,
disaggregated by type of punishment, for the past year.

Please
provide us with data for the past year on the number of prisoners
identified as sick (by type of illness) and number identified as mentally
disabled.

Please provide us with the number of prisoners receiving medical
treatment in prison facilities and the number admitted to community
facilities, by month, for the past year. Please provide us with data on
the number of prisoners tested and treated with antiretroviral drugs for
HIV (not including antibiotic (or Septrin) treatment) and tuberculosis for
the past year.

Please
provide us with information on donor funding to the UPS, including the
amounts contributed to each project by each donor, over the past year.

Please
provide us with a copy of the Fiscal Year 2010-2011 UPS budget.

Please
provide us with a copy of the UPS Standing Orders.

We hope to hear back from you by
April 29, 2011. Please email any response to burnetm@hrw.org or fax to +44
(0)20 7713 1800.

[11] Remand
homes are located at Fort Portal, Gulu, Naguru (in Kampala), and Mbale.
Children convicted of crimes are placed in the Kampiringisa National
Rehabilitation Centre. In some, non-profit organizations provide educational or
other services. Foundation for Human Rights Initiative, “Juvenile Justice
in Uganda: Report for the Period January-July 2009,” undated. In
accordance with international law, Ugandan law defines children as individuals
under the age of 18 and prohibits their detention with adults. Children Act of
1997, sec. 2 & 89(8).

[29] Uganda
Human Rights Commission, “12th Annual Report,” 2009. In 2010, per
10,000 people, there was one physician, less than one dentist, and 13 midwives.
WHO, “World Health Statistics.” Foundation for Human Rights
Initiative, “The Right to Healthcare in Uganda,” 2010,
http://www.fhri.or.ug/executive%20summary%20research%20report.pdf (accessed
April 25, 2011) (reporting that as a result of understaffing, patients waited
for four to six hours to see a nurse at health centers).

[31]Annie
Kelly, “Healthcare a Major Challenge for Uganda,” The Guardian,
April 1, 2009.

[32]There
are not enough community health centers or hospitals. In theory, there are
supposed to be healthcare facilities at the parish, sub-county, and county
levels, as well as a hospital at the district level. Richard Kavuma,
“Uganda’s Healthcare System Explained,” The Guardian,
April 1, 2009. However, at least 26 districts in Uganda do not have a hospital,
and patients must walk 12 kilometers in order to reach the nearest community
health center. Foundation for Human Rights Initiative, “The Right to
Healthcare in Uganda.” On average, rural residents live 5.2 km and urban
residents 2.9 km from the nearest health center. Uganda Bureau of Statistics,
“National Service Delivery Survey,” 2004,
http://openmicrodata.wordpress.com/category/uganda/ (accessed April 25, 2011).

[33]
Foundation for Human Rights Initiative, “The Right to Healthcare in
Uganda.”

[37] International Covenant on Civil and Political
Rights (ICCPR), adopted December 16, 1966, G.A. Res. 2200A (XXI), 21 U.N. GAOR
Supp. (No. 16) at 52, U.N. Doc. A/6316 (1966), 999 U.N.T.S. 171, entered into
force March 23, 1976, acceded to by Uganda on June 21, 1995, art. 10; United
Nations (UN) Standard Minimum Rules for the Treatment of Prisoners (Standard
Minimum Rules), adopted by the First United Nations Congress on the Prevention
of Crime and the Treatment of Offenders, held at Geneva in 1955, and approved
by the Economic and Social Council by its resolution 663 C (XXIV) of July 31,
1957, and 2076 (LXII) of May 13, 1977, paras. 9-11; United Nations (UN) Human
Rights Committee, General Comment 21, Article 10, Humane Treatment of Persons
Deprived of Liberty (Forty-fourth session, 1992), Compilation of General
Comments and General Recommendations Adopted by Human Rights Treaty Bodies, UN
Doc. HRI/GEN/1/Rev.7 (1994), paras. 9 and 13. See also Prisons Act of 2006,
sec. 64(1).

[40] UN Standard
Minimum Rules for the Treatment of Prisoners, paras. 9-19. These standards,
although non-binding, have been recognized as the minimum standards acceptable
to the international community through adoption by the General Assembly.

[41] In March 2010:
Luzira Upper was at 366 percent of approved capacity; Luzira Women’s at
357 percent; Murchison Bay at 128 percent; Butuntumura at 893 percent; Muduuma
at 3,200 percent; Kitalya at 104 percent; Masaka Main at 333 percent; Masaka
Ssaza at 1,611 percent; Muinaina at 269 percent; Jinja Main at 247 percent;
Jinja Women’s at 133 percent; Fort Portal Men’s at 213 percent;
Fort Portal Women’s at 86 percent; Bubukwanga at 1,343 percent; Masafu at
490 percent; Mutufu at 785 percent. It should be noted that while researchers
did seek to visit some prisons on the basis of their overcrowding, researchers
did not visit prisons in the Northern region of the country, which in March
2010 was the single most crowded region. UPS, “Summary of UPS Prisoners
Statistical Returns.”

[43] Human Rights
Watch facility tour with prison warden, Luzira Upper Prison, November 9, 2010.
Diversity exists, however, between the sleeping arrangements at different
prisons, and even within prisons. At Murchison Bay, Fort Portal Men’s and
Women’s, Jinja Women’s, and Masafu Prisons, prisoners did not
consistently complain about sleeping arrangements. At some prisons, some senior
inmates or those with resources are given significantly more sleeping space.

[59]
UN Standard Minimum Rules for the Treatment of Prisoners, para. 20(1). This
standard has been cited with approval by the UN Human Rights Committee when
examining the minimum standards that a state must observe for those deprived of
their liberty, “regardless of a state party’s level of
development.” See Mukong v. Cameroon, No. 458/1991, para. 9.3.

[67]
Human Rights Watch interview with enrolled midwife, Kitalya Farm Prison,
February 28, 2011. The prison medical authority also reported: “In 2008,
we had a nutrition assessment, which observed that the intake was not
commensurate to the requirements for prisoners, especially in the farm. We
recommended an improvement be made available for the prisoners on the farm. The
implementation is not yet there. I don’t know what that situation
is.” Human Rights Watch interview with prison medical authority, UPS,
March 11, 2011.

[69] Human Rights
Watch interview with prison medical authority, UPS, November 18, 2010. See also
UPS, “Work Plan and Budget,” p. 5 (demonstrating that the diet is
deficient in fat and calcium, and consists of no Vitamin A or C whatsoever);
Human Rights Watch interview with doctor, Murchison Bay Hospital, November 10,
2010 (noting that eye conditions as a result of lack of Vitamin A are
“very common”); The Republic of Uganda Office of the Auditor
General, “Value for Money Audit Report on Uganda Prisons Service,”
p. iv (concluding that “[t]he quality of the food served did not meet all
the basic food nutrients necessary for a healthy balanced diet”).

[75]
The World Health Organization recommends that mothers known to be HIV-infected
should only give infant formula as a replacement when safe water and sanitation
are assured, sufficient formula can reliably be provided, and it may be
prepared cleanly and carry a low risk of diarrhea and malnutrition. WHO,
“Guidelines on HIV and Infant Feeding,
http://whqlibdoc.who.int/publications/2010/9789241599535_eng.pdf (accessed May
13, 2011), pp. 7-8. In Uganda, national guidelines recommend that HIV-positive
mothers opt for replacement feeding if affordable, feasible, acceptable, sustainable
and safe, yet acknowledge that most Ugandan mothers cannot meet this standard.
Richard Hasunira, Aaron Muhinda, Rosette Mutambi and Beatrice Were,
“Uganda,” in Missing the Target: Failing Women, Failing Children:
HIV, Vertical Transmission, and Women’s Health, International Treatment
Preparedness Coalition, May 2009, p. 62.

[78]
Food and firewood requirements for 2009/10 should have totaled slightly under
21.73 billion Uganda shillings ($8.67 million); however, as a significant
proportion of food is grown on UPS farms (totaling 4.35 billion shillings or
$1.74 million), and 17.27 billion shillings ($6.89 million) were allocated from
funding from the government of Uganda under that year’s budget, no
substantial funding gap should have existed. The Republic of Uganda Office of
the Auditor General, “Value for Money Audit Report of Uganda Prisons
Service,” pp. 11-12. In 2011, the prison medical authority reported that
24 billion Uganda shillings ($9.58) were required to provide adequate food for
all the prisoners, but the governmental budget available for food that year and
the following one would be 14 billion Uganda shillings ($5.59 million), with
the gap covered by prison-produced food. Human Rights Watch interview with prison
medical authority, UPS, March 11, 2011.

[80] Human Rights
Watch interview with Phillip, Muduuma Prison, November 12, 2010. See also Human
Rights Watch interview with Paul, Muduuma Prison, November 12, 2010.
International standards and Ugandan law dictate that drinking water be
available to every prisoner whenever he or she needs it. UN Standard Minimum
Rules for the Treatment of Prisoners, para. 20(2); Prisons Act of 2006, sec.
69(2).

[93] Human Rights
Watch interviews with Grace, Masaka Ssaza Prison, November 22, 2010; Ross,
Masafu Prison, March 8, 2011. Systems where prisoners are obliged to use
buckets in their cells as toilets which they then empty—known as
“slopping out”—have been condemned by the European Committee
on the Prevention of Torture and the European Court of Human Rights as a violation
of the prohibition on inhuman and degrading treatment.

[104]
The International Labor Organization’s Convention 29 on Forced Labor,
which Uganda has ratified, states that only convicts can be compelled to work
in prison; such work must at all times be supervised by a public authority; and
prisoners may not be “hired to or placed at the disposal of private
individuals, companies or associations,” which means that prison labor
for private entities may be only by consent of the prisoner, whether
convict or remand. International Labor Organization, “Convention 29 on
Forced Labor,” ratified by Uganda on June 4, 1963,
http://www.ilo.org/ilolex/cgi-lex/convde.pl?C029 (accessed April 11, 2011); Lee
Swepston, “Prison Labour and International Human Rights,”
Industrial Relations Research Association, June 2001,
http://www.leeswepston.net/prison.htm (accessed April 11, 2011). UN Standard
Minimum Rules for the Treatment of Prisoners, para. 73(1).

[105]
International Labor Organization, “Convention 29 on Forced Labor,”
art. 11. See also UN Standard Minimum Rules for the Treatment of Prisoners,
para. 71(2) (stating that prison labor is subject to the “physical and
mental fitness” of prisoners as determined by a medical officer).

[111]
JLOS stated that one of its major achievements in reducing labor was the
mechanization of farm prisons, reducing the number of hours worked per day from
eight hours to seven hours in 2009-2010. Justice Law and Order Sector,
“Annual Performance Report,” September 2010. Private landowners who
had previously hired prison labor reported that prisoners worked as many as
nine hours a day on their land, sometimes seven days a week. Human Rights Watch
interviews with farmers, near Sentema Prison and Kasangati Prison, January 20,
2011; farmers near Ntenjeru Prison, January 21, 2011.

[136]
The Republic of Uganda Office of the Auditor General, “Value for Money
Audit Report of Uganda Prisons Service,” p. iv. The auditor general
further declared that lack of documentation and accountability led to
under-declaration and under-supply of food, compounding food shortages in
prisons. Ibid., p. 12.

[137]
At Muinana Farm Prison, Human Rights Watch researchers found remanded and
committed prisoners working. Prison escape records also indicated that a
remanded prisoner from Muinaina Farm Prison was reported by prison authorities
to have escaped from the “M/Shamba,” indicating the
“main” government-owned field, in 2010. Letter from prison
authorities to Human Rights Watch, June 29, 2011.

[139]
Human Rights Watch interviews with farmers, near Sentema and Kasangati Prisons,
January 20, 2011; farmers, near Ntenjeru Prison, January 21, 2011. An OC with
100 prisoners working six days a week could earn around 7,200,000 Uganda
shillings a month (approximately $3,060). Prisoners had various colloquial
terms for work for private contractors such as, “ekigaali,”
“kibawula,” “parties,”and “bed
shamba two.” By contrast, going to work on prison land is called
“federo” or “main shamba.”

[148]
Email communication from prison authorities to Human Rights Watch, May 19,
2011. Information provided by prison authorities to Human Rights Watch on
prisoner escapes in 2010 indicated that remanded and convicted prisoners were
reported to have escaped from “staff shamba [field].” Letter from
prison authorities to Human Rights Watch, June 29, 2011.

[149]
Human Rights Watch interview with OC, Muinaina Prison, March 4, 2011. Wardens
make roughly between 250,000 Uganda shillings and 375,000 shillings
(approximately $100 to $160) per month in salary. Housing in barracks for
wardens and their families is also usually provided. Human Rights Watch
interview with OC, Mutufu Prison, March 7, 2011.

[157]
For example, some prisoners at Masaka Ssaza, Masaka, Jinja Main, Muinaina, and
Masafu stated that they were paid 200 to 500 Uganda shillings for work on
private farms. Prisoners with authority to supervise other prisoners were
sometimes given 500 Uganda shillings ($0.25) out of the warden’s tips
while others were not, and in many cases, no prisoner received any
remuneration. Human Rights Watch interviews with Ali, Murchison Bay, November
20, 2010; Mafabi, Butuntumura Prison, November 11, 2010; Musa, Muduuma Prison,
November 12, 2010.

[158] Under Ugandan
law, prisoners upon admission to prison are to be provided with written
information on regulations related to the treatment of prisoners in that
category; disciplinary requirements of the institution; and the complaints
procedure. Prisons Act of 2006, sec. 58(5)(a)-(c). Furthermore, “A
prisoner shall not be punished for a prison offence until the prisoner has had
an opportunity of hearing the charge against him or her and making a defence
and where necessary and practicable, the prisoner shall be allowed the services
of an interpreter.” Prisons Act of 2006, sec. 96.

[163] Prisoners
consistently said that smoking (cigarettes or marijuana), engaging in same-sex
sexual conduct, refusing or delaying to work, trying to escape, fighting with
other prisoners, or stealing would entail either a beating, incarceration in an
isolation cell, or both. In some cases, minor disciplinary offences also were
considered to merit these punishments, such as dirtying the shower area leading
to a beating or use of a mobile phone to a week in an isolation cell.
Frequently, prisoners expressed to researchers their fear that speaking with
outsiders about the problems in prison would earn them a beating. Prisoners
also said that they were beaten at some prisons when they requested medical
care. Punishment for sexual conduct was particularly severe.

[164]
According to prison authorities, “There is … one punishment that is
currently outlawed and that’s Corporal Punishment. This is now treated as
assault and purely a Police case [case to be investigated by police].”
Email communication from prison authorities to Human Rights Watch, May 19,
2011.

[179]
Mental disabilities, as discussed in this report, include diagnosable mental,
behavioral, or emotional conditions that substantially interfere with or limit
one or more major life activity. Persons with mental health problems also refer
to themselves as having psychosocial disabilities, a term that reflects the
interaction between psychological differences and social/cultural limits for
behavior as well as the stigma that the society attaches to persons with mental
impairments.

[188] Prisons
Act of 2006, sec. 81(2). Furthermore, punishment by confinement should only
take place after an examination and certification of fitness by a medical
officer. Prisons Act of 2006, sec. 94.

[203] Constitution
of 1995, art. 24. The Prisons Act also explicitly states that prisoners are
entitled to “be treated with the respect due to his/her inherent dignity
and value as a human being.” Prisons Act of 2006, sec. 57(a).

[205] Human
Rights Watch facility assessment, Jinja Main Prison, March 1, 2011. The prison
warden, however, contended that the man was bewitched and so it was not
necessary to take him for medical treatment. Ibid. The OC at Masaka Ssaza
Prison said that he had isolated “a man with mental problems” in
the same cell used for punishment while he was awaiting transport to Murchison
Bay Hospital. Human Rights Watch interview with OC, Masaka Ssaza Prison,
November 22, 2010.

[215]
Prison authorities wrote to Human Rights Watch that “few health units are
submitting returns and those submitted are incomplete” and not submitted
in a timely manner. Letter to Human Rights Watch from prison authorities, June
29, 2011. Information collected by prison authorities and provided to Human
Rights Watch on the number of reported health conditions was not comprehensive
or representative of the prison population and is not presented in this report.

[216]
UPS, “Work Plan and Budget,” p. 4. See also Human Rights Watch
interview with prison medical authority, UPS, November 18, 2010 (“Most of
our structures are very poor. They don’t allow in air or sufficient
light. What do you expect? The transfer of infections such as TB take advantage
of that. And they are overcrowded. You can see the scenario.”). As well
as being the most common opportunistic infection among people living with HIV
in Africa, TB is pervasive in African prisons because of overcrowding, poor
ventilation, and lack of prevention practices. UNODC, UNAIDS and World Bank,
“HIV and Prisons in Sub-Saharan Africa: Opportunities for Action,”
p. 2; E. Rutta et al., “Tuberculosis in a Prison Population in Mwanza,
Tanzania (1994-1997),” The International Journal of Tuberculosis and
Lung Disease, vol. 5(8), 2001, pp. 703-06.

[218] Human
Rights Watch interview with director, National TB and Leprosy Programme, March
10, 2011; World Health Organization, “Global Tuberculosis Control: A
Short Update to the 2009 Report,” 2009,
http://whqlibdoc.who.int/publications/2009/9789241598866_eng.pdf (accessed
October 6, 2010), p.5. High-burden countries are defined as the countries that
rank first to 22nd in the world in terms of absolute numbers of TB cases and
which have received particular attention at the global level since 2000. Ibid,
p. 4.

[219] Republic
of Uganda Ministry of Health, “Manual of the National Tuberculosis and
Leprosy Programme,” March 2010, p. 3.

[220] Uganda
Prisons Service and United Nations Office on Drugs and Crime (UNODC), “A
Rapid Situation Assessment of HIV/STI/TB and Drug Abuse Among Prisoners in
Uganda Prisons Service: Final Report,” 2008,
http://www.unodc.org/documents/hiv-aids/publications/RSA_Report.pdf (accessed
August 11, 2010).

[232]
Human Rights Watch interview with prison medical authority, UPS, March 11,
2011. National TB guidelines in Uganda note that prisoners are a risk group for
drug-resistant tuberculosis. Republic of Uganda Ministry of Health,
“Manual of the National Tuberculosis and Leprosy Program,” p. 47.

[233]
Between 1996 and 2006, the coverage of directly observed treatment,
short-course (DOTS) expanded from 0 to 100 percent. The DOTS treatment success
rate among new sputum smear positive cases was 73 percent. World Health
Organization, “Country Profile: Uganda,” 2008, http://www.who.int/tb/publications/global_report/2008/pdf/uga.pdf
(accessed August 10, 2010). DOTS coverage is defined as the percentage of the
national population living in areas where health services have adopted DOTS.
DOTS treatment success rate is defined as the percentage of new smear-positive
patients that are cured (negative on sputum smear examination), plus the
percentage that complete a course of treatment, without bacteriological
confirmation of a cure.

[237]
Letter from prison authorities to Human Rights Watch, June 29, 2011. Data on
prisoner deaths were incomplete and therefore total mortality from TB in the
prison system in 2010 could not be ascertained.

[238]
See, e.g., Human Rights Watch interviews with Lubega, 17, Bubukwanga Prison,
November 16, 2010; OC, Muduuma Prison, November 12, 2010. Furthermore, serious
shortages of TB medications at those facilities which do dispense drugs have
occurred in Uganda as a result of delays in supply by the Global Drug Facility.
Human Rights Watch interview with director, National TB and Leprosy Programme,
March 10, 2011.

[244] UNAIDS, “Report on the Global AIDS
Epidemic: Annex 1,” 2010,
http://www.unaids.org/documents/20101123_GlobalReport_Annexes1_em.pdf (accessed
May 5, 2011), p. 181. This prevalence is down from rates over 10 percent
through much of the 1990’s, but an increase from 2007’s 5.4
percent. World Health Organization, UNAIDS, and UNICEF, “Epidemiological
Fact Sheet on HIV and AIDS: Core Data on Epidemiology and Response:
Uganda,” 2008,
http://apps.who.int/globalatlas/predefinedReports/EFS2008/full/EFS2008_UG.pdf
(accessed August 10, 2010).

[247] Human
Rights Watch interviews with prison warden, Kitalya Farm Prison, February 28,
2011; OC, Muinaina Farm Prison, March 4, 2011; Tabu Butagira and Lulu Jemimah,
“Prisons Chief—Sodomy Is My Biggest Headache,” The Monitor,
June 21, 2009, http://allafrica.com/stories/200811240127.html (accessed April
10, 2011). To a far lesser extent than male prisoners, female prisoners also
stated that sexual activity occurred and that it was punished. Human Rights
Watch interview with Stella, Jinja Women’s Prison, March 2, 2011
(“The wardens had beaten up some people who were engaging in [same-sex
sexual activity], but I hadn’t seen. There is a girl here we suspect, the
prisoners do isolate her. Even the wardens stopped her from going
outside.”); Vivian, Jinja women’s Prison, March 2, 2011 (“I
heard about it [same-sex sexual activity] in Kamuli, between two women. The
ladies complained about them, and reported that they engaged in lesbian
activities.”).

[248] See,
e.g., Human Rights Watch interviews with Yusuf, Murchison Bay Prison, November
13, 2010 (“It is common....Food is traded for sex—that’s how
it’s done.”); Peter, Masaka Main Prison, November 23, 2010
(“Some people try to befriend the new people here on remand. They give
them things like sugar cubes. Then they will take them to the toilet and have
sexual activities…. I found two people having sex, many times.”);
Adam, Masaka Main Prison, November 23, 2010 (“People who have been here more
than two years without visitors are sometimes accepting any offer because they
need to survive. Sugar, bread, or anything you can eat is given to these
people, and they are enticed to having sex.”); Joshua, Masaka Main
Prison, November 23, 2010 (“The rich people [with visitors] give the poor
people [those without visitors] things like soap, sugar, or bread in exchange
for sex. When they catch them, they take them to the cell.”); Kevin,
Muinaina Farm Prison, March 3, 2011 (“It is the prison leaders who engage
in homosexuality. They [non-leaders] become their wives. They prepare food for
them.”); Tobias, Muinaina Farm Prison, March 4, 2011 (“It is
because of greed, of not being able to avail yourself with the essential things
you would need. So one who had money would send for things like rice,
meat—the other would be attracted to those things and they would ask him
to have sex with him so he can give him food. He even gives him money to buy
whatever he wanted.”); Gabriel, Jinja Main Prison, March 1, 2011 (“Some
also use enticements, like edibles. Someone can use rice meal.”); Ralph,
Luzira Upper Prison, November 9, 2010 (“Sex? Yes, they do that. Someone
may exchange rice, or food—he gets what he wants.”).

[255]
UNAIDS, “WHO Guidelines on HIV Infection and AIDS in Prisons,” UNAIDS
Best Practice Collection, 1993,
http://data.unaids.org/Publications/IRC-pub01/JC277-WHO-Guidel-Prisons_en.pdf
(accessed March 3, 2010), p. 5. WHO, UNAIDS, UNODC, “Policy Brief:
Reduction of HIV Transmission in Prisons,” Doc. No. WHO/HIV/2004.05
(2004), p. 2. In 2007, the WHO, UNODC, and UNAIDS noted that studies have found
condom provision in prisons to be feasible, acceptable to prisoners, acceptable
to prison staff, and did not have negative consequences such as compromising
prison safety or security. Furthermore, “[f]ears about the provision of
condoms leading to more consensual and non-consensual sex were not
realized.” WHO, UNODC, UNAIDS, “Interventions to Address HIV in Prisons:
Prevention of Sexual Transmission,” 2007, p. 13.

[258] Human
Rights Watch interview with prison medical authority, UPS, November 18, 2010.
Prisoners’ reactions to the idea of distributing condoms in the prison
ranged from bewilderment (“what is the use of it as a prisoner?”)
to disapproval (“they should not be here, those who do it should be
arrested”) to fear that the introduction could lead to an increase in a
practice of which many inmates strongly disapprove (“it would promote
homosexuality”). Human Rights Watch interviews with Edgar, Murchison Bay
Prison, November 13, 2010; Peter, Masaka Main Prison, November 23, 2010;
Kakooza, Masaka Main Prison, November 23, 2010.

[263]
Informed consent is a well-established element of international guidance on HIV
testing. WHO and UNAIDS, “Guidance on Provider-Initiated HIV Testing and
Counselling in Health Facilities,” March 2007,
http://whqlibdoc.who.int/publications/2007/9789241595568_eng.pdf (accessed June
26, 2011).

[265]
Between 2004 and 2009, the number of people on antiretroviral therapy rose from
44,000 to 200,413. However, a significant gap of people requiring ART who were
not receiving it still existed. WHO, UNIDS, and UNICEF, “Epidemiological
Fact Sheet on HIV and AIDS: Core Data on Epidemiology and Response:
Uganda,” 2008,
http://apps.who.int/globalatlas/predefinedReports/EFS2008/full/EFS2008_UG.pdf
(accessed August 10, 2010); UNAIDS, “Report on the Global AIDS Epidemic:
Annex 2,” 2010,
http://www.unaids.org/documents/20101123_GlobalReport_Annexes2_em.pdf (accessed
May 5, 2011), p. 252.

[266] UNODC
and UPS reported in 2008 that only 100 prisoners on antiretroviral therapy
could be documented, but in that same year the Uganda Human Rights Commission
suggested that 2,050 prisoners (out of a total population of 28,205) were on
ART and cotrimoxazole (Septrin). UPS and UNODC, “A Rapid Situation
Assessment of HIV/STI/TB and Drug Abuse Among Prisoners in Uganda Prisons
Service.” Uganda Human Rights Commission, “11th Annual Report of
the Uganda Human Rights Commission to the Parliament of Uganda,” 2008, p.
45. On the day of researchers’ visits, 345 patients at Luzira Upper were
reportedly on some form of HIV treatment; 56 at Murchison Bay were reportedly
on ART. Human Rights Watch interview with Kiyonga, Luzira Upper Prison,
November 9, 2010; Human Rights Watch interview with doctor, Murchison Bay
Hospital, November 10, 2010. Prison authorities reported to Human Rights Watch
that, at the 15 prisons providing data during the period of July to December
2010, 1,465 prisoners were on ART. Letter from prison authorities to Human
Rights Watch, June 29, 2011.

[272]
Letter from prison authorities to Human Rights Watch, June 29, 2011. Data on
prisoner deaths were incomplete and therefore total mortality from HIV/AIDS in
the prison system in 2010 could not be ascertained.

[303] See,
e.g., Human Rights Watch interview with Ralph, Luzira Upper Prison, November 9,
2010. Diarrhea was a cause of death among prisoners in 2007/08 and 2008/09, and
cholera in 2005/06. The Republic of Uganda Office of the Auditor General,
“Value for Money Audit Report of Uganda Prisons Service,” p. 28.

[304] UPS,
“Work Plan and Budget,” p. 5. Diarrhea and dysentery were both
reported among the causes of prisoner deaths in 2010. Letter from prison
authorities to Human Rights Watch, June 29, 2011.

[311] Protocol
to the African Charter on Human and Peoples’ Rights on the Rights of
Women in Africa (Maputo Protocol), adopted by the 2nd
Ordinary Session of the Assembly of the Union, Maputo, CAB/LEG/66.6 (September
13, 2000); entered into force November 25, 2005. Ratified by Uganda on
July 22, 2010.

[333] The
lack of a psychiatrist on staff has resulted in reliance on a doctor visiting
from Butabika Hospital, Uganda’s sole psychiatric center. However, the
doctor’s visit can be as infrequent as once a month. Human Rights Watch
interview with OC, Murchison Bay, November 10, 2010. The lack of personnel
trained in mental health and therefore able to determine competency to stand
trial is an issue not only in the prison system but in the country as a whole,
where there are only 32 psychiatrists nationwide. Human Rights Watch interview
with president, Uganda Medical Association, March 11, 2011.

[336] Individuals
found not guilty “by reason of insanity” (or who are found guilty
and sentenced to death as minors) must await orders from the Minister of
Justice and Constitutional Affairs for his decision on whether that person will
be detained in a prison, a hospital, or other place of custody, or
alternatively released. Trial on Indictments Act, secs. 48 and 105. In reality,
however, because the Minister of Justice flouts his statutory duty to resolve
such cases, these prisoners remain in legal limbo for years without knowing how
long they will be detained, where they should be detained, or whether they are
entitled to release. Human Rights Watch, “Uganda: Languishing Behind
Bars: Resolve Overdue Cases of Prisoners with Mental Disabilities,” April
28, 2011, http://www.hrw.org/en/news/2011/04/28/uganda-languishing-behind-bars.

[337] This
statistic was derived using an entry screening process by UPS, still in its
very early stages. Human Rights Watch interview with prison medical authority,
UPS, March 11, 2011. Uganda has ratified the Convention on the Rights of
Persons with Disabilities. Convention on the Rights of Persons with
Disabilities (CRPD), adopted December 13, 2006 by G.A. Res. 61/106, Annex I,
U.N.GAOR, 61st Sess., Supp. No. 49 at 65, U.N. Doc A/61/49 (2006),
entered into force May 3, 2008, U.N. Doc. A/61/61, signed by Uganda on March
30, 2007 and ratified by Uganda on September 25, 2008.

[346]
At Jinja Main, a major regional center, Human Rights Watch researchers found a
prisoner with “mental problems” shut away in an isolation cell. He
reported that he had received no medication or visits from a health worker.
Human Rights Watch facility assessment of Jinja Main Prison, March 2, 2011. A
psychiatrist visits Murchison Bay from the Butabika mental hospital, and a
clinical psychiatric officer and psychiatric nurse are on staff. But even at
Murchison Bay Hospital, prisoners housed in the mental health cell reported
simply receiving medication from another inmate. Human Rights Watch interviews
with Elliot, Murchison Bay Prison, November 13, 2010; Ali, Murchison Bay
Prison, November 20, 2010; Drani, Fort Portal Men’s Prison, November 15,
2010.

[351] Defilement,
defined as “a sexual act with another person who is below the age of
eighteen years,” accounts for roughly a third of all capital cases in
prisons. There is a wide literature on the use of the crime as a means of
extracting civil redress for families, often in instances of consensual
relationships. Penal Code Amendment Act of 2007, sec. 2. UPS, “Census of
Prisoners in 48 Central Government Prisons,” September 30, 2007. In 2008,
due to the high number of defilement cases, the law was amended to allow
magistrate’s courts as well as High Courts to hear such cases.

[352]
Chief Justice of Uganda Benjamin Odoki, “Speech at the Case Backlog
Review,” March 7, 2011. Capital offences must be heard by a High Court,
while lesser offences can be heard by either a magistrate’s court or High
Court.

[353]
Justice Law and Order Sector, “Annual Performance Report,”
September 2010.

[356]
UPS in 2007 said that of inmates in the central region, where adherence to law
is usually best in the country, 70 percent were not taken within this 48-hour
period. UPS, “Census of Prisoners in 48 Central Government
Prisons.” Only 15 percent prisoners Human Rights Watch surveyed were
taken to court within this time period. The vast majority stay in police
stations for long periods of times—in some cases up to several months—without
understanding the charges against them and in overcrowded cells without water
or bathing facilities, in some instances without even being allowed to contact
relatives. Human Rights Watch interviews with Roger, Masaka Ssaza Prison, November
22, 2011; Ross, Masafu Prison, March 8, 2011; Kenneth, Masafu Prison, March 8,
2011; Benjamin, Masafu Prison, March 8, 2011; Lucas, 17, Masafu Prison, March
8, 2011; Obua, Masaka Prison, March 23, 2010; Byamukama, Masaka Ssaza Prison,
November 22, 2010.

[360] A
recent study of over 2,000 remand detainee records documented that in 32
percent of cases examined, capital detainees had been detained over 180 days
prior to committal, and non-capital detainees had been detained for over 60
days before commencement of trial. That study attributed long remand times to
issues including unlawful arrests by a multitude of overlapping security
forces, a shortage of judges and magistrates, lack of legal representation,
poor trial administration, and ineffective investigation practices. Avocats
Sans Frontieres and University of Toronto International Human Rights Program,
“Presumed Innocent, Behind Bars: The Problem of Lengthy Pretrial
Detention in Uganda,” 2011. Furthermore, Uganda’s auditor general
has noted that, among almost 40,000 criminal cases handled between July 2006
and June 2010, only 18 percent had been completed within 12 months, the maximum
target for completion of capital cases. The Republic of Uganda Office of the
Auditor General, “Value for Money Audit Report on Disposing of Cases in
the Judiciary,” March 2011, p. 19 (citing the Judiciary Staff Handbook,
p. 56).The auditor general attributed long remand times to a combination of
problematic court procedures, inadequate infrastructure , low staffing levels,
and lack of monitoring and evaluation of the judiciary. The Republic of Uganda
Office of the Auditor General, “Value for Money Audit Report on Disposing
of Cases in the Judiciary.”

[362]
Human Rights Watch interview with OC, Muinaina
Prison, Mubende District, March 3, 2011. Mubende, Mityana, Kasanda,
Kiboga, and Kyankwanzi are the five districts the court covers. According to
prisoners, it sat only once the previous year, and for only two months. Human
Rights Watch interviews with Bradley, Muinaina Prison, March 3, 2011; Mohamed,
Muinaina Prison, March 4, 2011.

[363]
The Ugandan constitution states, “In the determination of…any
criminal charge, a person shall be entitled to a fair, speedy and public
hearing before an independent and impartial court or tribunal established by
law.” Article 28(1).

[364]
In one recent study, detainees under the jurisdiction of the High Court spent
an average of 488 days on committal from the date of committal to the date of
data collection. Avocats Sans Frontieres and University of Toronto
International Human Rights Program, “Presumed Innocent, Behind
Bars,” p. 34.

[367]
Human Rights Watch, “Violence Instead of Vigilance: Torture and Illegal
Detention by Uganda’s Rapid Response Unit,” March 23, 2011,
http://www.hrw.org/en/reports/2011/03/23/violence-instead-vigilance; Avocats
Sans Frontieres and University of Toronto International Human Rights Program,
“Presumed Innocent, Behind Bars,” 2011; Human Rights Watch
interview with OC, Kigo Prison, November 19, 2009. The African Commission,
interpreting the African Charter on Human and Peoples’ Rights, has
prohibited the trial of civilians in military courts. The African Charter, to
which Uganda is a party, guarantees the right to equality before the law and
equal protection of the law, fair trial, and judicial independence. The African
Charter does not admit any exceptions to the rule against the use of military
courts to try civilians, such as emergency situations. The Commission’s
Principles and Guidelines on the Right to a Fair Trial and Legal Assistance in
Africa also prohibits the trial of civilians in military courts. Law Office
of Ghazi Suleiman v. Sudan, Comm. Nos. 222/98 and 229/99, para. 64 (African
Commission on Human and Peoples’ Rights 2003); Media Rights Agenda v.
Nigeria, Comm. No. 224/98, paras. 60-66 (African Commission on Human and
Peoples’ Rights 2000). African (Banjul) Charter on Human and
Peoples’ Rights art. 2, June 27, 1981, 21 I.L.M. 58 (entered into force
Oct. 21, 1986) [hereinafter African Charter], arts. 2, 3, 7, and 26. African
Commission on Human and Peoples’ Rights, Principles and Guidelines on the
Right to a Fair Trial and Legal Assistance inAfrica (Nov. 1999)

[369]
Justice, Law, and Order Sector, “Annual Performance Report,
2009-2010,” September 2010. Uganda’s auditor general notes that the
case backlog increased from 65,423 in FY 2006/07 to 126, 521 in 2009/10. The
Republic of Uganda Office of the Auditor General, “Value for Money Audit
Report on Disposing of Cases in the Judiciary,” March 2011, p. 1.

[370] Article
23(6) as amended by the Constitution of the Republic of Uganda (Amendment) Act
11/2005 provides: “(6) where a person is arrested in respect of a
criminal offence –(a) the person is entitled to apply to the court to be
released on bail and the court may grant that person bail on such conditions as
the court considers reasonable; (b) in the case of an offence which is triable
by the High Court as well as by a subordinate court, if that person has been
remanded in custody in respect of the offence for sixty days before trial, that
person shall be released on bail on such conditions as the court considers
reasonable; (c) in the case of an offence triable only by the High Court, if
that person has been remanded in custody for one hundred and eighty days before
the case is committed to the High Court, that person shall be released on bail
on such conditions as the court considers reasonable.” Before the
constitutional amendment, (b) and (c) stated 120 and 360 respectively as the
number of days that must pass before a person is entitled to bail. See alsoUganda v. Besigye, Constitutional Court of Uganda at Kampala,
Constitutional Reference No. 20 of 2005, September 22, 2006 in which the Court
held that under article 23 (6) (a) of the Constitution the court has a
discretion whether to grant bail or not to grant bail and that bail is not
automatic. However the Court also observed that “while considering bail
the court would need to balance the constitutional rights of the applicant. …
and the considerations which flow from people being remanded in prison custody
which adversely affects their welfare and that of their families and not least
the effect on prison remand conditions if large numbers of unconvicted people
are remanded in custody.” In Foundation for Human Rights Initiative
vs. the Attorney General, Constitutional Petition No. 20 of 2006, March 26,
2008 the Constitutional Court confirmed that Article 23(6) of the Constitution
confers discretion upon court whether to grant bail. Foundation for Human
Rights Initiative is appealing the ruling to the Supreme Court. Human Rights
Watch Interview with executive director, Foundation for Human Rights
Initiative, Kampala, March 9, 2011.

[372]
The Magistrates Court Act requires the Director of Public Prosecutions (DPP) to
provide the magistrate’s court with an indictment and a summary of the
case in order to commit a case to the High Court. Magistrates Court Act of
1971, sec. 168. The Trial on Indictments Act does not allow a person accused of
a criminal offence triable by the High Court to be produced in the High Court
unless and until such person has been committed for trial by the DPP. Trial on
Indictments Act of 1971, sec. 1. Due to the criminal process’s dependency
upon the speed of the DPP’s actions, prisoners can continue on remand
without any statutorily defined time limitations.

[374] See,
e.g., James Sebugenyi, “Bail is a Fundamental Right,” New Vision,
May 22, 2011, http://www.newvision.co.ug/D/8/20/755380 (accessed June 21,
2011); Ofwondo Opondo and Wafula Oguttu, “What Does the Proposed
Amendment to Scrap Bail Mean for Uganda?” Sunday Vision, May 21,
2011,
http://www.sundayvision.co.ug/detail.php?mainNewsCategoryId=7&newsCategoryId=614&newsId=755249
(accessed June 21, 2011). However, eliminating the possibility of bail for
nonviolent crimes is inconsistent with human rights standards, under which pretrial
restrictions must be consistent with the right to liberty and the presumption
of innocence. ICCPR, arts. 9 and 14. Indeed, under international law, the
presumption is that “It shall not be the general rule that persons
awaiting trial shall be detained in custody, but release may be subject to
guarantees to appear for trial.” ICCPR, art. 9(3).

[375]
For lesser crimes, the Magistrate’s Court’s Act says that courts
consider the nature and gravity of the charge, prior charges, whether the
suspect has a fixed abode, and the suspect’s likelihood to
“interfere with any of the witnesses” into consideration when
adjudging bail applications.” Magistrates Courts Act, Sec. 77(2). For
capital crimes, the High Court is to consider whether the suspect has a fixed
place of abode, sound securities, prior instances of failure to comply with
bail, or other charges. Trial on Indictment Act, sec. 15(4).

[376] Although
Article 23 (6) (a) of the Constitution (as amended) has been held to bestow
discretion on the courts as to whether to grant bail—where a person is
arrested in respect of a criminal offence the person is entitled to apply to
the court to be released on bail and the court may grant that person
bail—the Constitutional Court also held that is not true of articles 23
(6) (b) and (c). Article 23 (6) (b) provides that for “an offence which
is triable by the High Court as well as by a subordinate court” if a
person “has been remanded in custody for sixty days before trial, that
person shall be released on bail” on conditions set by the court. Under article
23 (6) (c) if the offence is triable only by the High Court, then bail is to be
granted if the accused has been in remand for 180 days. The Constitutional
Court has said that in the cases of both Article 23 (6) (b) and (c), bail must
be granted and there is no discretion. See Uganda v. Besigye, September 22,
2006. In practice, though, this does not happen.

[382]
The Uganda Paralegal Advisory Services dispatches its own paralegals and also
funds other legal aid organizations, such as AHURIO in Fort Portal, Uganda
Christian Lawyers Fraternity in Kampala, and Foundation for the Development of
Needy Communities in Mbale, as well as in some instances giving UPS social
workers training on paralegal services. Law & Development Partnership,
“Evaluation, Paralegal Advisory Services, 2007-2010,” January 7,
2011. For a description of legal aid services available in Uganda, see
generally, UN Office on Drugs and Crime, “Handbook on Improving Access to
Legal Aid in Africa,” 2011, http://www.unodc.org/documents/justice-and-prison-reform/Webbook_Legal_Aid_in_Africa_lr.pdf
(accessed April 25, 2011).

[383]
Sarah Callaghan, Chairperson JLOS Development Partners Group ,“JLOS
Development Partner Group Response to Annual Progress,” October 4-5,
2010.

[387]Law
& Development Partnership, “Evaluation, Paralegal Advisory Services,
2007-2010,” January 7, 2011; “Leave Bail Money Alone,” New
Vision, August 30, 2008; “Billions Lost in Bail Cash Abuse,” Monitor,
August 29, 2008; JLOS, “Report of the Joint JLOS/DPG Monitoring Visit,
Lango and Acholi Sub-Regions,” June 2010,
http://www.jlos.go.ug/uploads/m%20and%20E%20Report%202010.pdf (accessed April
11, 2011). The Inspectorate of Courts received 740 complaints of judicial
misbehavior in 2009-2010, though the government purported that it has taken
measures to combat corruption by conducting 71 inspections during that period.
Justice, Law, and Order Sector, “Annual Performance Report,
2009-2010,” September 2010. According to Transparency International,
Ugandans said on a scale of 1-5, with 5 being “extremely corrupt,”
they perceived the judiciary to be at 3.9. Transparency International,
“Global Corruption Barometer 2010,” 2010,
http://www.transparency.org/policy_research/surveys_indices/gcb/2010/results
(accessed April 28, 3011).

[404] One of
the children interviewed by Human Rights Watch was given the opportunity to
present evidence of her age via testimony of her brother, but the police
rejected it as false. Human Rights Watch interview with Hellene, 16,
Butuntumura Prison, November 11, 2010. All the other children said they told
police, court, and prison authorities their age but were ignored or accused of
lying. UPS is ostensibly supposed to ascertain that a person is not below 18
years on admission. The Republic of Uganda Office of the Auditor General,
“Value for Money Audit Report on Uganda Prisons Service,” p. 8.
However, conducting an age assessment requires particular protections for
children. According to the UN Committee on the Rights of the Child, children
should be informed about the purpose and the implications of an age assessment
and be given effective representation by a guardian and lawyer. Such exams
should not rely exclusively on physical appearances but should take into
account psychological maturity, demeanor, ability to interact with adults,
social and educational history, and life experiences. UN Committee on the
Rights of the Child, General Comment No. 6, para. 31(i). Jacqueline Bhabha and
Nadine Finch, “Seeking Asylum Alone: United Kingdom,”
http://www.ilpa.org.uk/seeking%20asylum%20alone.pdf (accessed July 8, 2009), p.
61.

[406] Human
Rights Watch interview with prison medical authority, UPS, March 11, 2011.
Prison authorities noted that “[s]ince the majority of prisoners (nearly
70%) are resident at the 63 units, it implies that only 30% of our prisoners
are not having access to a prisons health services run facility as the primary
point of contact for health care services.” Letter from prison
authorities to Human Rights Watch, June 29, 2011.

[417]
Human Rights Watch interview with OC, Masaka Main Prison, November 23, 2010. A
medical officer at Masaka, however, claimed that the deceased prisoner had
previously been at the outside hospital, but had been incompletely attended to
and that his death happened “out of the blue.” Human Rights Watch
interview with psychiatric nurse, Masaka Main Prison, November 23, 2010.

[421]
Human Rights Watch interview with Mafabi, Butuntumura Prison, November 11,
2010. Additional inmates at Butuntumura corroborated the death and that the
prisoner had not received treatment. See Human Rights Watch interviews with
Kakuru, Butuntumura Prison, November 11, 2010; Logan, Butuntumura Prison,
November 11, 2010.

[426]
The Prisons Service recently acquired an ambulance for upcountry referrals to
Murchison Bay, but more are required to avoid transfer delays. Human Rights
Watch interview with prison medical authority, UPS, November 18, 2010.

[427] The OC at Murchison Bay urged that at least a clinical
officer be posted in each health unit to improve timely referrals. Human Rights
Watch interview with OC, Murchison Bay Prison, November 10, 2010.

[440] UPS,
“Work Plan and Budget,” p. 14. Prison authorities report that in
2008, only 26 percent of health care posts were filled, and in FY2010/11 this
number had increased to 51 percent. Letter from prison authorities to Human
Rights Watch, June 29, 2011.

[441]
In November 2010, 222 of 436 (51 percent) of health posts established by UPS
were filled with professional health workers. In some regions, however, this
number fell far lower; in the northeastern region only six percent of established
posts had been filled. Human Rights Watch interview with prison medical
authority, UPS, November 18, 2010. Uganda’s Auditor General has concluded
that “[t]he staffing level in the Health Services Division is too low to
deliver adequate medical services in all prisons.” The Republic of Uganda
Office of the Auditor General, “Value for Money Audit Report of Uganda
Prisons Service,” p. 35.

[452] Not
all patients referred from Murchison Bay to Mulago Hospital are actually taken
because of limited transportation and human resources for the transfer. The
Republic of Uganda Office of the Auditor General, “Value for Money Audit
Report on Uganda Prisons Service,” p. 21.

[461]
In that final year, the amount of donor funding to the UPS was less than half
the amount of the “internally generated” revenue from
prisoners’ forced labor. The exception was FY 2006/07. The Republic of
Uganda Office of the Auditor General, “Value for Money Audit Report of
Uganda Prisons Service,” p. 4.

[466]
Human Rights Watch interview with prison medical authority, UPS, March 11,
2011. The first phase of the project, which is a collaboration under PEPFAR
between the CDC, USAID and UPS, will focus on assessing HIV, TB, STI, and
malaria epidemiology and service provision, in order to inform the development
and implementation of prevention, care and treatment services for staff and
prisoners. Ibid.